IL261281A - Devices and methods for left atrial appendage closure - Google Patents
Devices and methods for left atrial appendage closureInfo
- Publication number
- IL261281A IL261281A IL261281A IL26128118A IL261281A IL 261281 A IL261281 A IL 261281A IL 261281 A IL261281 A IL 261281A IL 26128118 A IL26128118 A IL 26128118A IL 261281 A IL261281 A IL 261281A
- Authority
- IL
- Israel
- Prior art keywords
- snare
- elongate body
- shuttle
- loop
- lumen
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0483—Hand-held instruments for holding sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/32056—Surgical snare instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
- A61B2017/0475—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery using sutures having a slip knot
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B2017/0496—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
Description
WO 2017/147519 PCT/US2017/019495
DEVICES AND METHODS FOR LEFT ATRIAL APPENDAGE CLOSURE
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority to U.S. Provisional Application No. 62/300,608, filed
February 26, 2016 and titled “DEVICES AND METHODS FOR LEFT ATRIAL APPENDAGE
CLOSURE,” which is hereby incorporated by reference in its entirety.
FIELD
[0002] The innovations disclosed herein relate generally to devices and methods for ligating
tissue, such as the left atrial appendage, using surgically, minimally invasive, or intravascular
approaches.
BACKGROUND
[0003] Atrial fibrillation is a common problem that afflicts millions of patients. Atrial fibrillation
often results in the formation of a thrombus, or clot, in the appendage of the left atrium. This
presents a problem, inasmuch as the thrombus can dislodge and embolize to distant organs, which
may result in adverse events such as a stroke. For this reason, most patients with atrial fibrillation
are treated with one or more blood thinners to help prevent the formation of a thrombus. Blood
thinners, however, can present health risks of their own, especially in the elderly. These risks, such
as bleeding, often require a user to make significant lifestyle changes.
[0004] Several methods have been developed to address the potential problem of thrombus
formation in the left atrial appendage. One such method includes suturing the left atrial appendage
along the base or ostial neck where it joins the atrial chamber. In this way, blood flow into the atrial
appendage is cut off, eliminating the risk of thrombus formation therein. Other methods have also
been investigated. These methods include stapling the base of the appendage and filling the
appendage with a space-occupying or occluding member. Stapling is not preferred given the
fragility of the appendage and its tendency to rupture, whereas occlusion devices may not
effectively prevent all blood flow into the appendage.
1WO 2017/147519 PCT/US2017/019495
[0005] Most of these procedures are typically performed through open-heart surgery; however,
some may also be performed using minimally invasive techniques. Open-heart surgery may limit
the availability of these procedures to those who are at a particularly high risk, or who are otherwise
undergoing an open-heart procedure. In addition, open-heart surgery requires general anesthesia
and has a number of well-known risks, which may make it less desirable for some. Therefore,
additional devices and methods for closing the left atrial appendage using minimally invasive,
intravascular, or a combination of these techniques would be desirable in order to avoid the need for
opening the chest.
[0006] However, at times, the closure of the left atrial appendage is a concomitant procedure
during other cardiac procedures, and performing the closure during an open-heart procedure may
provide benefits in comparison to a minimally invasive procedure. For example, performing the
closure during an open-heart procedure may make it easier for instruments to access the heart and
may allow for better control or maneuverability of those instruments. Additionally, using an
open-heart approach may provide a better view of the heart and the surrounding tissue during the
procedure. Thus, additional devices for use in open surgical procedures are desirable, especially
when those devices offer additional advantages over standard devices.
BRIEF SUMMARY
[0007] Described here are devices, systems, and methods for closing the left atrial appendage. In
general, the devices described here for closing a target tissue comprise an elongate body comprising
a lumen therethrough. A snare loop assembly may be provided and may comprise a snare and a
suture loop releasably coupled to the snare. The snare loop assembly may extend at least partially
from the elongate body. A shuttle may be connected to a distal portion of the snare and releasably
coupled to the elongate body. The shuttle may comprise a configuration to fit into the lumen.
[0008] In some variations, the elongate body may comprise an approximately L-shaped recess in
a side wall of the elongate body. The distal portion of the snare may be positioned in the recess
when the shuttle is coupled to the elongate body.
2WO 2017/147519 PCT/US2017/019495
[0009] In some instances, the device may comprise a lock wire configured to releasably couple
the shuttle to the elongate body. The shuttle may comprise a snare lumen and a proximal portion of
the snare lumen may comprise an offset obround.
[0010] In some variations, a distal portion of the elongate body may comprise a corner chamfer.
A tip may be coupled to the distal portion of the elongate body. The tip may comprise a tip lumen
and a proximal portion of the tip may comprise a tip chamfer. The tip chamfer may be 30 degrees
and offset from the tip lumen.
[0011] The device may include additional features. The elongate body may comprise a shuttle
recess and the shuttle may be disposed within the shuttle recess when the shuttle is coupled to the
elongate body. In some variations, the device may comprise a first configuration in which the
shuttle is fixedly coupled to the elongate body and a second configuration in which the shuttle is
positioned within the lumen. In some instances, the shuttle may have a maximum dimension that is
less than a diameter of the lumen. A diameter of the lumen of the elongate body may be equal to or
less than about 1.60 mm.
[0012] In some instances, the devices described here may comprise an elongate body, a snare loop
assembly, a shuttle, and a handle. The snare loop assembly may comprise a snare and a suture loop
releasably coupled to the snare. The snare loop assembly may extend at least partially from the
elongate body. The shuttle may be releasably coupled to the elongate body and may be connected
to a distal portion of the snare. The handle may be attached to the elongate body. The handle may
comprise a track, a snare control coupled to the track, and a release assembly housed within the
handle. The snare control may comprise a limiter configured to limit movement of the snare control
along a proximal portion of the track, and the release assembly may be configured to release the
shuttle from the elongate body and disengage the limiter to allow movement of the snare control
along the proximal portion of the track.
[0013] In some variations, the device may comprise a suture control for tightening the suture
loop. The suture control may comprise a proximal portion configured to engage the release
assembly through an opening in the handle and disengage the limiter from the release assembly.
3WO 2017/147519 PCT/US2017/019495
The release assembly may comprise a flexible latch configured to limit movement of the release
assembly after engagement of the suture control to the release assembly. The limiter may extend
along a length of the track and/or a lock wire may be configured to releasably couple the shuttle to
the elongate body.
[0014] In some variations, the devices described here may comprise an elongate body, a snare
loop assembly, a shuttle, and a handle comprising a lock configured to limit movement of the snare
control along the track. The snare loop assembly may comprise a snare and a suture loop releasably
coupled to the snare and the snare loop assembly may extend at least partially from the elongate
body. The shuttle may be releasably coupled to the elongate body and may be connected to a distal
portion of the snare. The handle may be attached to the elongate body and may additionally
comprise a track, a snare control coupled to the track, and a release assembly configured to release
the shuttle from the elongate body and allow movement of the snare control along the track.
[0015] In some of these variations, the devices may further comprise a suture control configured
to tighten the suture loop. The suture control may comprise a proximal portion configured to
engage the release assembly through an opening in the handle and disengage the lock from the
release assembly. In some variations, the lock may comprise a stopper extending along a length of
the track. The lock may further comprise a lock engagement portion comprising an opening and the
opening may be releasably coupled to the release assembly. In some variations, the release
engagement portion may extend from a bottom surface of the stopper. The release assembly may
comprise a release engagement portion and the lock engagement portion may be releasably coupled
to the release engagement portion. In some variations, the release engagement portion may
comprise a base and a protrusion, and the protrusion may be configured to fit within the opening of
the lock to releasably couple the lock engagement portion and the release engagement portion. In
some instances, the lock may further comprise an end plate. Additionally, in some variations, the
device may comprise a lock wire configured to releasably couple the shuttle to the elongate body.
[0016] Also described here are methods of closing a target tissue. In general, the methods may
comprise advancing a device towards the target tissue. The device may comprise an elongate body,
4WO 2017/147519 PCT/US2017/019495
a snare loop assembly comprising a snare and a suture loop, and a shuttle connected to the snare and
releasably coupled to the elongate body. The snare loop assembly may be closed around the target
tissue. The suture loop may be released from the snare loop assembly. The shuttle may be released
from the elongate body. The shuttle may be retracted into a lumen of the elongate body. The suture
loop may be tightened around the target tissue. Methods may also comprise withdrawing the device
from the body.
[0017] In one variation, shuttle retraction may be performed prior to tightening the suture loop. In
some instances, the method may further comprise opening the closed snare loop assembly.
Tightening of the suture loop may be performed prior to releasing the shuttle from the elongate
body. Tightening of the suture loop may be performed after opening the closed snare loop
assembly. In some variations, opening the closed snare loop assembly may further comprise
bending the distal end portion of the snare freely away from the elongate body. In some variations,
a maximum shuttle diameter may be less than a diameter of the lumen of the elongate body. In
some instances, the device may further comprise a handle attached to the elongate body and the
handle may comprise a track, a snare control coupled to the track, and a lock configured to limit
movement of the snare control along the track. The handle may further comprise a release assembly
configured to release the shuttle from the elongate body and allow movement of the snare control
along the track. In some of these instances, the track may comprise a first portion and a second
portion, and the lock may limit movement of the snare control along the second portion of the track.
[0018] The methods may include additional variations. In some variations, the suture loop may
be tightened via a suture control. In some of these variations, the device may further comprise a
handle coupled to the elongate body and retracting the shuttle may further comprise inserting a
portion of the suture control through an opening in the handle, engaging a release assembly with the
inserted portion of the suture control, and disengaging a lock from the release assembly. In some of
these variations, the handle may comprise a snare control and a track with a first portion and a
second portion, and retracting the shuttle may further comprise removing the lock from a second
portion of the track and moving the snare control along the second portion of the track.
5WO 2017/147519 PCT/US2017/019495
[0019] In further variations of the methods, the snare control may comprise a limiter configured to
limit movement of the snare control along the track. A release assembly may be configured to
release the shuttle from the elongate body and allow movement of the snare control along the track.
The track may comprise a first portion and a second portion, and the limiter may be a lock
configured to limit movement of the snare control along the second portion of the track.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] FIG. 1 provides a cross-sectional representation of a heart showing various anatomical
structures.
[0021] FIG. 2 is a perspective view of an illustrative closure device that may be used to close the
left atrial appendage.
[0022] FIG. 3 A is a view of a distal end of an illustrative variation of a closure device having a
snare loop assembly. FIGS. 3B-3F are side views of the closure device shown in FIG. 3A.
[0023] FIG. 4 is an exploded perspective view of a variation of a closure device.
[0024] FIGS. 5A and 5B are perspective views of a variation of a closure device having a
retractable snare. FIG. 5C is a top view of the closure device shown in FIG. 5A.
[0025] FIG. 6A is a side view of a variation of an elongate body and tip of a closure device. FIG.
6B is a perspective view of the elongate body and tip shown in FIG. 6A.
[0026] FIGS. 7A and 7B are cross-sectional views of a variation of an elongate body and tip of a
closure device.
[0027] FIG. 8 is a perspective view of a proximal end of a tip of a closure device.
[0028] FIGS. 9A and 9B are perspective views of a variation of a shuttle for a retractable snare.
[0029] FIG. 10 is a sectional view of a variation of a shuttle in a lumen of a tip of a closure
device.
6WO 2017/147519 PCT/US2017/019495
[0030] FIGS. 11 A-l IB and 1 ID-1 IE are perspective views of an illustrative variation of a handle
assembly for use with the closure devices described here. FIG. 11C is a top view of the handle
assembly shown in FIG. 1 IB.
[0031] FIG. 12 shows a perspective view of a suture control for use with a handle assembly.
[0032] FIGS. 13A-13B are cross-sectional perspective views of a variation of a handle assembly
of a closure device.
[0033] FIGS. 14A and 14C are cross-sectional perspective views of another variation of a handle
assembly of a closure device. FIG. 14B is a cross-sectional side view of the handle assembly shown
in FIG. 14A.
[0034] FIG. 15A is a cross-sectional perspective view of yet another variation of a handle
assembly of a closure device. FIG. 15B is a cross-sectional side view of the handle assembly shown
in FIG. 15 A.
[0035] FIG. 16A is a flowchart for one variation of a tissue closing process. FIGS. 16B-16G are
perspective views of a snare loop assembly and handle assembly corresponding to FIG. 16A.
[0036] FIG. 17A is a flowchart for another variation of a tissue closing process. FIGS. 17B-17G
are perspective views of a snare loop assembly and handle assembly corresponding to FIG. 17A.
[0037] FIG. 18 is a perspective view of a variation of a closure device having a partially
retractable shuttle.
DETAILED DESCRIPTION
[0038] Described here are devices, systems, and methods for closing tissue, for example, the left
atrial appendage. In instances where the heart is the relevant anatomy, it may be helpful to briefly
identify and describe the relevant heart anatomy. FIG. 1 is a cross-sectional view of the heart (100)
Shown there are the left atrium (102) and the left ventricle (104). In between the left atrium (102)
and the left ventricle (104) is the mitral valve (also known as the bicuspid valve), which is defined
7WO 2017/147519 PCT/US2017/019495
by a pair of mitral valve leaflets (106). The leaflets are connected to chordae tendinae (108) that are
connected to papillary muscles (110). The papillary muscles join the ventricular wall (112). The
left atrial appendage (114) is shown adjacent to, and is formed from, the wall of the left atrium
(102).
[0039] As can be seen, the left atrial appendage (114) lies within the boundaries of the
pericardium (116) and is in close proximity to the ventricular wall (112). The left atrial appendage
typically has a tubular shape that approximates a cone, with a slight narrowing or neck in the plane
of the orifice where it joins the left atrium (102). In patients with atrial fibrillation, the left atrial
appendage (114) is the most common location for thrombosis formation, which, in time, may
dislodge and cause a devastating stroke. Because stroke is the primary complication of atrial
fibrillation, the left atrial appendage is frequently excluded from the left atrium in those patients
undergoing procedures to treat atrial fibrillation, and is often removed or excluded at the time of
other surgical procedures, such as mitral valve surgery, to reduce the risk of a future stroke. The
devices and systems described here help ensure proper closure of the left atrial appendage at the
neck or base of the left atrial appendage, along the anatomic ostial plane. In this way, exclusion of
the entire left atrial appendage from systemic circulation may be facilitated.
I. Devices
[0040] Described here are closure devices and methods for closing tissues using these closure
devices. Generally, the closure devices comprise an elongate body and a snare loop assembly that
may extend at least partially from the elongate body to capture and hold tissue. The snare loop
assembly typically comprises a closure element, for example, a snare, and a suture loop releasably
coupled to the snare. The snare loop assembly may be closed around tissue to temporarily or
permanently close, ligate, or otherwise tighten tissue, and the suture loop may be tightened and
released from the snare to hold or otherwise maintain the tissue in the closed configuration. Either
before or after the suture loop is tightened, the snare loop assembly may be retracted into the
elongate body to facilitate the removal of the closure device from confined body spaces. The
8WO 2017/147519 PCT/US2017/019495
closure device may include one or more mechanisms that prevent premature retraction of the snare
loop assembly.
[0041] FIG. 2 depicts one illustrative variation of closure device (200) that may be used to close
the left atrial appendage. Shown there are a snare loop assembly (202), an elongate body (204), and
a handle (206). As noted above, the handle (206) may be used to control and actuate the snare loop
assembly (202) through the elongate body (204) in order to move snare loop assembly (202)
between a closed configuration, an open deployed configuration, and a retracted configuration.
When in an open configuration, the snare loop assembly (202) and elongate body (204) may form a
continuous loop (208) (e.g., such that the snare loop assembly (202) and the elongate body (204)
may fully encircle tissue placed in the loop (208)). When moved from the open configuration to the
closed configuration, the size of the loop (208) may be reduced as some or all of the snare loop
assembly (202) is withdrawn into the elongate body (204). Finally, in the retracted position, the
loop (208) (e.g., a snare and a retention member) may be provided entirely within the elongate body
(204). Alternatively, in the retracted position, a substantial portion of the loop (208) may be
provided within the elongate body with a small portion of the loop (208) remaining outside of the
elongate body (204).
[0042] The closure devices described here may be suitable for advancement to the left atrial
appendage using minimally invasive (e.g., through a small incision above, beneath, or through the
rib cage, through an incision in the costal cartilage or the xiphoid, through a port, through the
vasculature, and the like) and surgical (e.g., median sternotomy, mini sternotomy, thoracotomy,
thoracoscopy, and the like) approaches.
[0043] FIG. 3A shows a distal section of an illustrative variation of a closure device (300)
comprising a snare loop assembly (302) and an elongate body (304) having tip (306). As shown
there, the snare loop assembly (302) may comprise a snare (308), a suture loop (310), and a
retention member (312), and may be disposed relative to the elongate body (304) such that at least a
portion of the snare loop assembly (302) extends from the elongate body (304) (e.g., via tip (306)).
The snare loop assembly (302) is shown in FIG. 3A in an open configuration, and the portion of the
9WO 2017/147519 PCT/US2017/019495
snare loop assembly (302) extending out of elongate body (304) may form a loop (314) having an
aperture (316) therethrough. The loop (314) and the corresponding aperture (316) may be defined
by one or more components of the snare loop assembly (302) (e.g., the snare) and may be suitable
for encircling tissue such as the left atrial appendage. Generally, the snare (308) may be used to
open and close the snare loop assembly (302). In some instances, the retention member (312) may
be configured to releasably couple the suture loop (310) and the snare (308) and may be configured
to release the suture loop (310) from the snare loop assembly (302) upon application of a sufficient
force to suture loop (310).
[0044] A snare loop assembly may further comprise a shuttle to allow a distal portion of a snare
loop to be released from a tip of the elongate body to allow the snare loop to be retracted into a
lumen of the tip. Retraction of the snare loop into the tip reduces a profile of the device to improve
removal of the device from a body. For example, retraction of the snare into the elongate body may
prevent the snare from catching on and/or damaging tissue when the device is removed from the
body after the shuttle is released from the tip. The shuttle may function to releasably connect the
snare loop to the tip. A user may control the release of the shuttle through the handle. FIG. 5A is a
perspective view of a closure device (500) having an elongate body (502) comprising a tip (503), a
shuttle (516), and a retractable snare comprising a proximal portion (512) and a distal portion (514).
The shuttle (516) may be connected to the distal portion (514) of the snare and releasably coupled to
the tip (503) of the elongate body (502). While depicted comprising a tip (503), the elongate body
(502) need not. In variations in which a tip is not used, the shuttle may be coupled to a side wall of
the elongate body (e.g., at a distal portion or end of the elongate body).
[0045] When the closure devices are advanced through confined body spaces, such as the
pericardial space, advancement or manipulation of the snare loop assembly within or through these
tight spaces may result in portions of the snare, such as an end of the snare protruding from the
elongate body, to curve and bend to a greater degree than other portions of the snare. To form a
snare loop, the snare may curve as it leaves a tip of the elongate body. A curve of the snare may
induce a shift or tilt in components connected to the snare relative to the elongate body due to
friction of the snare against the tip.
10WO 2017/147519 PCT/US2017/019495
[0046] For instance, a conventional shuttle connected to the snare may shift or tilt upward out of a
recess of a tip due to the forces generated by a curve of the snare. An uneven interference is thus
generated where the curved portion of the snare contacts a sidewall of the tip. Consequently,
frictional forces may create misalignment of the shuttle with the tip, which may make assembly and
operation of the device difficult. Additionally, in some instances, bending or manipulation of the
snare loop assembly within a confined space may create undesirable interference from tissue that
may become pinched between the snare and the tip. Accordingly, devices described herein may be
configured to allow the snare to bend freely without rubbing or abutting against the elongate body,
which may reduce interference, misalignment and tissue pinching.
[0047] Additionally, a conventional snare loop may be releasable in that a distal portion of the
snare loop may be detached from the tip to allow for easier removal of the snare loop from around
the tissue disposed within the loop. However, after releasing a distal portion of the snare loop, the
portion of the snare that was encircling the tissue and a shuttle remain exposed and external to the
elongate body. This exposed portion of the snare and the shuttle may interact with and catch onto
anatomical features or the suture as the closure device is moved away from the target tissue.
Accordingly, devices described herein below may be configured to allow the snare and the shuttle to
fully retract into the elongate body such that no portion of the snare or shuttle remains exposed. In
other variations, the devices described herein may be configured to allow almost the entire snare
loop (e.g., a majority of the snare loop exposed during a procedure, 2/3 of the exposed snare loop,
/6 of the exposed snare loop, and the like) and thus the snare to retract into the elongate body such
that the shuttle and a small portion of the snare remains outside the elongate body.
[0048] In addition to having an elongate body and a snare loop assembly, closure devices
described here typically comprise one or more mechanisms for controlling manipulation and
advancement of the elongate body and/or the snare loop assembly. For example, a handle or other
control mechanism (e.g., a surgical master-slave robotic system) may be used to control and actuate
the snare loop assembly through the elongate body. The handle or other control mechanism may
change the snare loop assembly between a delivery, or “closed,” configuration and a deployed, or
11WO 2017/147519 PCT/US2017/019495
“open,” configuration, and vice versa. Additionally, the handle or other control mechanism may
move the snare loop assembly into a retracted configuration.
[0049] Placing the snare loop assembly in a closed configuration may allow for a low-profile
advancement of the snare loop assembly to a target location and/or may allow the snare loop
assembly to close around a target tissue. Conversely, placing a snare loop assembly in an open
configuration may allow the snare loop assembly to be placed around one or more target tissues
and/or may allow the snare loop assembly to release one or more target tissues previously closed by
the snare loop assembly. Accordingly, the devices described herein may further include a handle
and/or one or more other control mechanisms to control release of the suture loop from the snare
loop assembly, as well as snare release and retraction. The closure devices may further include
mechanisms that prevent an operator from retracting the snare and shuttle prior to releasing the
shuttle from the tip.
[0050] The closure devices may contain one or more additional features, as will be described in
more detail below. In some variations, a chamfer may be added to a distal portion of the elongate
body that is covered or partially covered by a tip, which may prevent the tip from cracking due to
tight tolerances. In other variations, a height of the tip may be increased relative to the elongate
body to reduce stress on the tip, increase clearance, and provide leeway for the elongate body to
distort within the tip. The manufacturability and reliability of the closure devices are thus
improved. These and other features will be described in more detail below. It should be
appreciated that the closure devices described here may comprise any combination of these features
and the other features described and/or incorporated by reference.
[0051] The closure devices described here may include any suitable elements or combinations of
elements such as those described in U.S. Patent Application No. 14/195,797, entitled “Tissue
Ligation Devices and Methods Therefor” and filed on March 3, 2014, the contents of which are
incorporated by reference herein in its entirety. Individual components of the closure devices
described here will be described in more detail below.
12WO 2017/147519 PCT/US2017/019495
Elongate Body
[0052] As mentioned briefly above, the closure devices described here may generally comprise an
elongate body. The elongate body may connect the distal end of the snare loop assembly and the
handle or actuating mechanism while still allowing for control of the snare loop assembly through
the elongate body. Specifically, at least a portion of some of the snare loop assembly components
may be housed within the elongate body, and may be connected to the handle through the elongate
body. In some variations, at least a portion of the elongate body may be flexible, which may help
facilitate navigation of the elongate body through the body.
[0053] The elongate body may generally comprise a tip at the distal end thereof. In some
variations, the tip of the elongate body may be formed separately from the elongate body, and may
be attached to the elongate body during assembly of the device. For example, in some variations,
the tip and the elongate body may be attached by a sliding fit and/or adhesive. In other variations
the tip portion may be formed integrally with the elongate body as a unitary device. The tip portion
may serve a number of useful functions for the closure device. In some instances, the tip may be
configured to be atraumatic, which may act to reduce the risk of damaging tissue as the proximal
end of the elongate body is moved within the body. In other instances, the tip may allow certain
portions of the snare to pass through a lumen of the elongate body while holding other portions in
place relative to elongate body, as will be described in more detail below.
[0054] The tip may have the same number of lumens as the elongate body, but need not. Indeed,
in some variations, the tip may divide one or more lumens of the elongate body into two or more
sub-lumens. In other variations, the tip may alter the size or shape of one or more lumens of the
elongate body.
[0055] The elongate body may comprise various sections or portions with different
characteristics, for example, different diameters, cross-sectional shapes, stiffnesses, materials, and
the like, which may increase the steerability and maneuverability of the closure device.
13WO 2017/147519 PCT/US2017/019495
[0056] The elongate body may comprise any suitable length, and the length of the elongate body
may vary depending on the type of procedure being performed. The elongate body may be made of
any suitable material, for example, one or more polymers (e.g., polyether block amide,
polyethylene, silicone, polyvinyl chloride, latex, polyurethane, PTFE, nylon, and the like). During a
minimally invasive procedure, the elongate body may have to travel a further distance through the
body to reach a target tissue than when the device is used in a surgical procedure. Thus, it may be
desirable to use a longer elongate body when using the device in a minimally invasive procedure
and a shorter elongate body when using the device in a surgical procedure.
[0057] Moreover, the elongate body may comprise any suitable cross-sectional shape, for
example, circular, oval, D-shaped, triangular, and the like. In some embodiments, the cross-
sectional shape of the elongate body may vary along its length. In some variations, the elongate
body may be described as having multiple portions, each portion corresponding to a specific cross-
sectional shape. For example, the elongate body may comprise a proximal portion with a first
cross-sectional shape (e.g., circular) and a distal portion with a second cross-sectional shape (e.g.,
D-shaped). Of course, the elongate body may comprise any suitable number of portions, e.g., two,
three, or four portions, and the length of each portion may be the same as or different from the other
portions.
[0058] The elongate body may also comprise any suitable outer diameter, and, in some instances,
the outer diameter of the elongate body may also vary along its length. For example, in instances in
which the closure device is used during a minimally invasive procedure, it may be desirable to limit
the outer diameter of the elongate body such that it may fit through 13-French percutaneous tubing.
[0059] The elongate body may further comprise one or more transitions connecting the portions
of the elongate body comprising different diameters or different cross-sectional shapes. These
transitions may have any suitable length.
14WO 2017/147519 PCT/US2017/019495
Lumens
[0060] The elongate bodies described here may have any suitable number of lumens. As used
herein, “lumen” may refer to any bore or passageway extending through or partially through a
length of the elongate body or other portion of the closure device (e.g., through a handle). It should
be appreciated that a lumen need not be entirely enclosed (i.e., the lumen may comprise one or more
slots, slits, gaps, or other openings along some or all of the length of the lumen). The elongate body
may comprise one, two, three, four, or five or more lumens. Some or all of the lumens may extend
entirely through the elongate body (i.e., from the proximal end of the elongate body to the distal end
of the elongate body). Other lumens may pass through only a portion of the elongate body (e.g.,
from one end to an intermediate point along the elongate body, or between two intermediate points
along the elongate body).
[0061] The various components of the snare loop assembly may be housed within any lumen or
lumens of the elongate body. For example, in some variations, all of the components of the snare
loop assembly may be housed in a single lumen. In other variations, different portions of the snare
loop assembly may be at least partially housed in different lumens. For example, the free end of the
suture loop may pass to the handle through a first lumen, while the free end of the snare may pass to
the handle through a second lumen. In some variations, there may be excess suture housed within
the elongate body, and this excess suture may be housed in any suitable lumen. For example, the
excess suture may be held in the same lumen as the free end of the suture loop, in the same lumen as
the free end of the snare, or in an altogether different lumen.
[0062] While the lumens shown herein are depicted in specified locations within the elongate
body, the lumens may be positioned in any location within the elongate body (i.e., their centers may
be moved and their locations shifted); however, it may be desirable to maintain a minimum wall
thickness between the lumens to prevent breakthrough. For example, in some variations, it may be
necessary to heat the elongate body after it is extruded or otherwise manufactured to attach, insert,
or bond with other elements to the closure device. Heating the elongate body may cause the lumens
to shift locations or change in size. In some instances, a portion of the material separating the two
15WO 2017/147519 PCT/US2017/019495
lumens may sever such that the lumens converge or otherwise come together forming one lumen
instead of two.
[0063] In order to decrease the likelihood of this breakthrough, it may be desirable to maintain a
minimum distance between the lumens during extrusion and/or heating. Additionally, as described
above, in some variations, a portion of the elongate body may comprise a D-shaped cross-section,
which may be created by cutting, shaving, skiving, or otherwise removing a portion of the elongate
body. In these variations, maintaining a minimum wall thickness between the lumens may prevent
the lumens from shifting during heating and becoming severed when the elongate body is cut to
create the D-shape. Accordingly, in some variations, it may be desirable to maintain at least about a
0.005” (0.127 mm) wall thickness between the lumens.
[0064] Additionally, in some variations, the lumens may comprise a lining or a coating designed
to reduce the frictional forces between the internal surface of the lumens and the components
housed within them. The small size of the lumens, their relative locations, the materials used, and
the precision required to fabricate the elongate body may result in manufacturing variations (e.g.,
different frictional characteristics inside the lumens) between different lots and/or different
manufacturers. These variations may lead to an inconsistent user experience and may result in
frustration with the closure device and/or improper usage. For example, if the frictional forces
between the internal surface of the suture lumen and the suture vary, the user may be required to
apply different amounts of force to tighten the suture each time the device is used. This may result
in over or under tightening of the suture around the tissue. Accordingly, in some embodiments, the
suture lumen may comprise a friction-reducing lining or coating (e.g., a polytetrafluoroethylene
(PTFE)). It may be desirable to include a friction-reducing lining in any and/or all of the lumens of
the elongate body, as doing so may result in a more consistent and predictable user experience.
Tip
[0065] In some variations, the tip of the elongate body may be formed separately from the
elongate body and the tip may be coupled to the elongate body by sliding the tip over the distal end
of the elongate body. FIGS. 6A and 6B are side and perspective views of a variation of an elongate
16WO 2017/147519 PCT/US2017/019495
body (604) and a tip (602) of a closure device (600). In this variation, the tip (602) and the elongate
body (604) are configured to provide a sliding fit where the elongate body (604) is secured within a
cavity (610) of the tip (602). The distal end portion (606) of the elongate body (604) may comprise
a corner chamfer (608), which may help prevent the tip (602) from cracking or becoming damaged
by removing a contact point between the distal end portion (606) of the elongate body (604) and the
tip (602) where stress may concentrate.
[0066] In one particular variation, the outermost diameter of the elongate body (604) may be
0.148 inches ± 0.002 inches (3.7592 mm ± 0.0508 mm), the height of the distal end (606) may be
0.096 inches ± 0.002 inches (.24384 mm ± 0.0508 mm), an inside diameter of the tip (602) defining
the tip cavity may be 0.148 inches + 0.002/-0.001 inches (3.7592 mm + 0.0508/-0.0254 mm), and
an inside height of the tip may be 0.099 inches ± 0.002 inches (2.5146 mm ± 0.0508 mm).
[0067] In some variations, a gap or clearance may be formed between an external surface of the
elongate body and an internal surface of the tip (i.e., a surface of the cavity) once the distal end
portion of the elongate body is placed within the cavity of the tip. The gap or clearance formed
between the elongate body and the tip may assist in providing a consistent and reliable fit between
the elongate body and the tip, and may lower stress on the tip by providing more space for the
elongate body to distort within the tip. In some variations, the gap or clearance may be formed by
increasing an inner (and in some variations, an outer diameter) of the tip, while in other variations,
for example those in which a D-shaped tip is used, the diameter of the tip may remain constant
while the height of the tip may be increased.
[0068] FIGS. 7A and 7B are cross-sectional views of a variation of an elongate body (704)
positioned within a cavity of a tip (702). As shown in FIGS. 7A and 7B, the tip (702) and the
elongate body (704) may have a clearance (712) between them. The elongate body (704) may
comprise a first lumen (706), a second lumen (708), a third lumen (710), and corner chamfers (714).
The tip (702) and at least a portion of the elongate body (704) (e.g., a distal portion) may have a D-
shaped cross-sectional shape, each with a height (703, 705). In some variations, the height (703) of
the tip (702) may be larger than a height (705) of the distal portion of the elongate body (704) such
17WO 2017/147519 PCT/US2017/019495
that the clearance (712) is formed between the tip and the elongate body (e.g., between the flat or
linear bottom surfaces of the tip (702) and the elongate body (704)). The tip may have any suitable
height, however, it may be useful to size and configure the tip so that it does not interfere with other
components that may be used with the closure device during a closure procedure, for example, a
guidewire and/or a guide/delivery cannula. For example, in some variations, the height of the tip
may be selected such that the tip and a guidewire may fit (e.g., stacked) within a lumen of a delivery
cannula. Thus, in some variations, the height and thickness of the tip combined with the diameter of
the guidewire may be less than a diameter of a lumen of a delivery cannula, for example, a 13
French delivery cannula having a lumen diameter of about 0.174 inches.
[0069] For example, in some variations, it may be useful to utilize a tip (702) with an external
height in a range of about 0.115 inches (2.921 mm) to about 0.125 inches (3.175 mm).
Additionally, as mentioned above, the diameters/heights of the tip and the distal end of the elongate
body may be selected such that a suitable gap or clearance is created between them, for example, a
clearance between about 0.001 inches (0.0254 mm) and about 0.012 inches (0.305 mm). For
example, in some variations, the external height of the tip may be about 0.120” (3.048 mm), the
internal height (703) of the tip (702) may be about between about 0.099 inches ± 0.002 inches
(2.515 mm ± 0.0508 mm) and 0.104 inches ± 0.002 inches (2.642 mm ± 0.0508 mm), and the
height of the distal end of the elongate body may be between about 0.094 inches (2.388 mm) and
about 0.098 inches (2.489 mm). For example, as shown in FIG. 7A, in some variations, the height
(703) of the tip (702) may be about 0.106 inches (2.692 mm), which may provide a clearance (712)
height of about 0.012 inches (0.330 mm) when the distal end of the elongate body (704) is
positioned within the tip (702). In other variations, for example, the variation shown in FIG. 7B, the
height (703) of the tip (702) may be about 0.104 inches (2.642 mm), which may provide a clearance
(712) height of about 0.008 inches (0.2032 mm) relative to the elongate body (704). The foregoing
are simply examples and any combination of heights of the tip and distal end of the elongate body
(e.g., any combination of heights for each selected from values within the ranges contained above)
that result in a clearance between about 0.001 inches (0.0254 mm) and about 0.012 inches (0.305
mm) may be used.
18WO 2017/147519 PCT/US2017/019495
[0070] The front surface of the tip may also comprise one or more (e.g., two, three, four, or more)
lumens, which may, but need not, correspond to the lumens of the elongate body. The tip lumens
may have different diameters and/or cross-sectional shapes than one another. For example,
referring to the embodiment depicted in FIGS. 7A and 7B, the tip (702) may comprise first, second,
and third lumens corresponding to the first, second, and third lumens (706, 708, 710) of the elongate
body. While all the lumens are depicted as having a circular cross-sectional shape, this need not be
the case, and the lumens may have any suitable cross-sectional shape (e.g., oval, square, rectangular,
a combination thereof, and the like). Each lumen may have a different diameter or the same
diameter.
[0071] FIG. 8 depicts a perspective view of a proximal end portion of a tip (800) comprising a
front surface (808) with a first tip lumen (802) having a corresponding tip chamfer (804) and a
second tip lumen (806). In some instances, the tip may scuff or rub against a retention member
when a snare assembly is opened and closed. However, there may be difficulty in simply increasing
the diameter of the first lumen of the tip to reduce scuffing due to the space occupied by the
retractable snare and the recess occupied by the shuttle. In these instances, it may be desirable to
add a tip chamfer (804) to the first tip lumen (802) to reduce scuffing when the snare loop assembly
is open and closed. The tip chamfer (804) may have any suitable angle, for example, it may be a 30
degree chamfer offset from center of the first tip lumen (802) or between about 20 degrees and
about 60 degrees. In one variation, the diameter of first tip lumen (802) may be approximately
0.063 inches (1.60 mm).
Snare Loop Assembly
[0072] As mentioned above, the snare loop assemblies of the closure devices described here may
be used to temporarily close or restrict one or more target tissues. Generally, the snare loop
assembly comprises a closure element, e.g., a snare, and a suture loop releasably attached to the
closure element. In some variations, the snare loop assembly may comprise a retention member at
least temporarily connecting the closure element and the suture loop.
19WO 2017/147519 PCT/US2017/019495
[0073] In variations of snare loop assemblies comprising a snare, the snare may be at least
partially moveable to change a snare loop assembly between open, closed, and retracted
configurations. Generally, a portion of the snare may be housed in the elongate body, and another
portion of the snare may extend outside of the distal end of the elongate body to at least partially
define the loop and aperture of the snare loop assembly.
[0074] In some variations, one end of the snare is releasably fixed relative to one or more portions
of the closure device, while the other end may be advanced or retracted through the elongate body.
Movement of the free end of the snare may change the amount of the snare loop assembly that is
disposed outside of elongate body, and thus may change the size (e.g., diameter, circumference,
area, etc.) of the loop and the aperture defined thereby. Specifically, advancement of the free end of
the snare through the elongate body may increase the size of the loop and aperture of the snare loop
assembly, while retraction of the free end of the snare may decrease the size of the loop and aperture
of the snare loop assembly. The free end of the snare may be manipulated in any suitable manner.
In some variations, the snare may be attached directly to one or more portions of the handle. In
other variations, a hypotube, rod, or other rigid structure may be attached to the free end of the
snare. This structure may in turn be moved by the handle, which may help facilitate advancement
or withdrawal of the snare through the elongate body.
[0075] In a retracted configuration, the fixed end of the snare is released and an entirety of the
snare and shuttle are retracted into a lumen of the elongate body, as illustrated in, for example,
FIGS. 16F and 17F. The shuttle, which may be coupled to the distal (fixed) end of the snare, may
be configured to fit through a lumen in the tip and a lumen of the elongate body (e.g., a first lumen
(706) of the elongate body (704) as depicted in FIGS. 7A-7B, a first tip lumen (802) as depicted in
FIG. 8).
[0076] The closure elements or snares described here may be made of any suitable material or
combination of materials. For example, in some variations, the snare may be made from a
shape-memory material, such as a shape-memory alloy (e.g., a nickel titanium alloy, etc.), or may
be made from stainless steel, polyester, nylon, polyethylene, polypropylene, combinations thereof,
20WO 2017/147519 PCT/US2017/019495
and the like. In variations where the snare is made from a shape-memory material, the snare may be
configured to take on a particular shape or configuration when the snare loop assembly is placed in
an open configuration, but may still be at least partially withdrawn into the elongate body to place
the snare loop assembly in a closed configuration. For example, the snare may form a generally
circular, teardrop-shaped, oval or ellipsoid, or triangular loop when the snare loop assembly is
placed in an open configuration.
[0077] Furthermore, in some variations, the snare loop assembly may be angled relative to the
elongate body. As shown in FIGS. 3A and 3B, the plane of snare loop assembly (302) is
approximately perpendicular to the distal end of the elongate body (304), however, the plane of the
snare loop assembly (302) may be varied over a wide range of angles (a), as depicted in FIGS. 3B-
3F. For example, the angle (a) formed between the plane of the snare loop assembly (302) and the
distal end of the elongate body (304), may be between about 5 degrees and about 85 degrees (FIG.
3C), may be about 90 degrees (FIGS. 3A and 3B), may be between about 95 degrees and about 175
degrees (FIG. 3D), may be about 180 degrees (FIG. 3E), or may be between about 185 degrees and
about 270 degrees (FIG. 3F). In some variations, the angle (a) formed between the plane of the
snare loop assembly (302) and the distal end of the elongate body (302) may be between about 5
degrees and about 45 degrees. Angling the snare relative to the elongate body may aid the snare in
capturing tissue, as angling may better position the snare relative to tissue as the closure device is
moved in the body. In some variations, the angle (a) may be preset, while in other variations, the
angle (a) is adjustable within a predetermined range.
Suture Loop
[0078] The snare loop assemblies described here may also comprise a suture loop for maintaining
tissue in a closed manner. Generally, the suture loop may be releasably attached to the snare, for
example, via a retention member, as will be described in more detail below. Furthermore, the suture
loop may comprise a suture knot, but need not. This suture knot may be any suitable knot,
including, but not limited to, a slip knot (e.g., a one-way slip knot) or a Meltzer knot. In some
variations, at least a portion of the knot may be held within the tip of the elongate body. In other
21WO 2017/147519 PCT/US2017/019495
variations, the suture knot at least partially extends from the tip of the elongate body or may be
positioned outside of the tip and may be temporarily held in fixed relation to the elongate body.
When the suture loop comprises a suture knot, the suture loop may comprise a loop portion, a suture
knot, and a tail extending from the suture knot. The suture tail may be pulled through the suture
knot to reduce the diameter of the loop portion.
[0079] In variations where the suture loop comprises a slip knot, the suture may be advanced or
withdrawn through the slip knot to change the size of the suture loop. In instances where the suture
knot is held within or against a tip of the elongate body, the suture knot may not move while the size
of the suture loop is changed. This may help prevent the closure device from damaging tissue. In
some variations, the suture loop may comprise a unidirectional locking structure. In these
variations, the unidirectional locking structure may be any structure capable of being advanced
along the suture in one direction but resisting movement in a second direction. In these variations,
the locking structure may be advanced over a portion of the suture loop to help lock a suture knot in
place. For example, in some variations, the unidirectional locking structure may comprise a bead or
a mechanical structure that is placed at least partially around the suture. In these variations, the
bead may comprise one or more teeth or projections that allow the bead to be advanced along the
suture in one direction, but prevent or resist movement in the opposite direction. The locking
structure may be advanced via one of the closure devices described here, or it may be advanced by a
separate device after the suture loop has been released from the closure device.
[0080] The suture loop may be made from any suitable material useful in tissue exclusion or
closure. For example, it may be made of a biodegradable material (e.g., polylactic acid,
polyglycolic acid, polylactic-co-glycolic acid, etc.), or it may be made of a non-biodegradable
material (e.g., metal, steel, polyester, nylon, propylene, silk, combinations thereof, etc.).
[0081] When the suture loop is tightened to close tissue, it may be possible for tissue to be pulled
into the suture knot of the suture loop. If too much tissue is pulled into the suture knot, the suture
knot may clog or jam in a way that prevents the suture loop from being further tightened. In some
22WO 2017/147519 PCT/US2017/019495
variations the suture loop may comprise one or more pledgets or tube sections to help shield a
portion of the suture knot.
Retention Member
[0082] When the snare loop assemblies described here comprise a retention member releasably
coupling a snare and a suture loop, the retention member may be any suitable member, such as
dual-lumen tubing. In some variations, one lumen may have a slit, perforation, or other opening
along its length, which may allow the suture to pass therethrough when it is ready to be deployed.
The slit need not extend or be continuous along the entire length of the retention member. In some
variations, the slit may have prongs or arms along its length to help capture and retain the suture in
the retention member. In other variations, the slit may be covered at spaced-apart locations with a
biodegradable polymer, which may temporarily tack or hold down the suture. Of course, in still
other variations, the retention member does not comprise a slit, and instead comprises some other
type of retention mechanism, such as the prongs or tacks described just above. In yet other
variations, there are no slits or openings in the retention member, and the suture loop is released
upon removing or withdrawing the retention member.
Excess-Suture Management
[0083] In operation of the closure devices, it may be desirable to be able to open and close a
snare loop assembly without prematurely releasing the suture loop from the snare assembly.
Because the size of the loop of the snare loop assembly and the aperture defined thereby changes as
the snare loop assembly is opened and closed, it may be necessary for the size of the suture loop to
change in order to accommodate this change in aperture size and to prevent the suture from being
prematurely released from the snare loop assembly. In some variations, opening the snare loop
assembly may pull a suture through a slip knot to increase the size of the suture loop. This may,
however, provide sufficient force to the suture loop to cause the suture to break or sever.
[0084] To help prevent this undesirable outcome, in other variations, the suture loop may be sized
such that the suture loop is as large as or larger than the size of the aperture defined by the loop of
23WO 2017/147519 PCT/US2017/019495
the snare loop assembly when the snare loop assembly is in an open configuration. In this manner,
the suture does not translate through the knot while the suture is loaded on the device and the size of
the suture loop does not change. Thus, when the snare loop assembly is moved to either an open or
closed configuration, the suture loop can assume a similar size without needing to advance
additional suture through the suture knot.
[0085] Pre-sizing the suture loop to such a size, however, may result in extra slack in the suture
loop when the snare is in both the open and closed configurations. To help prevent the excess suture
from getting entangled with or caught on anatomical structures, instruments, or other obstructions,
some or all of the slack in the suture loop may be held inside of the elongate body when the snare
loop assembly is opened and/or closed. As such, the closure devices described here may comprise
one or more excess-suture management features, which may be used in any suitable manner. The
closure devices described here may comprise any suitable suture management features, for example,
any of those described in U.S. Patent Application No. 12/752,873, entitled “Tissue Ligation Devices
and Controls Therefor” and filed on April 1, 2010, the entire content of which is incorporated by
reference herein.
Retractable Snare
[0086] As mentioned above, in some variations, the closure devices described here may comprise
a retractable snare. In some variations, the snare may be configured to be releasable along its
length to separate the snare into two separate snare portions, as well as configured to be retractable
through a lumen of the elongate body. In other variations, the closure device may comprise a snare
having an end that is fixed relative to the elongate body, and the closure device may be further
configured to release the fixed end of the snare and retract the previously fixed end of the snare into
the elongate body. In some variations, the closure device may comprise a snare that has a fixed
distal portion that is releasable from a side wall of the elongate body (or a tip thereof). For example,
the closure device may comprise a first configuration in which a shuttle coupled to a distal end of
the snare is fixedly coupled to the elongate body, and a second configuration in which the shuttle
and the distal end of the snare are positioned within a lumen of the elongate body. In these
24WO 2017/147519 PCT/US2017/019495
variations, the fixed end of the snare, which may or may not be coupled to a shuttle, may be
released from the closure device in any suitable manner.
[0087] FIG. 4 is an exploded perspective view of a variation of a closure device. FIG. 4 shows a
perspective view of a distal portion of the closure device (400) comprising a tip (402), a shuttle
(420) comprising a window or lock wire recess (422), and a lock wire (424). As shown there, the
tip (402) may comprise a shuttle recess (408) having a rear surface (412) and a front surface (414),
first and second lumens (404, 406), an L-shaped recess (410) extending between the front surface
(414) of the shuttle recess (408) and a front surface of the tip (428), and a lock wire lumen (418).
Also shown there is a track (416) further disposed in the shuttle recess (408). When the shuttle
(420) is coupled to the tip (402), the shuttle may be positioned within the shuttle recess (408) and
optionally the track (416). The shuttle (420) may be connected to a distal portion of the snare (not
shown), which may be positioned in the approximately L-shaped recess (410), as will be described
in detail below.
[0088] The lock wire (424) may be configured to extend through the tip (402) and the shuttle
(420) and into the lock wire lumen (418). When sufficient force is applied to the lock wire (424)
(e.g., at a proximal end thereof), the lock wire (424) may be retracted and the shuttle (420) may be
released from the tip (402). In some variations, the lock wire (424) may comprise one or more
bends (426) or coils, which may resist movement relative to the shuttle and/or elongate body. The
bend (426) in the lock wire (424) may be configured to be disposed within the window or lock wire
recess (422) of the shuttle (420) while the shuttle (420) is coupled to the tip (402). The bend (426)
in the lock wire (424) may prevent low levels of force from retracting the lock wire (424) (i.e., may
reduce the risk of premature or inadvertent release) as the bend (426) may contact a side wall of the
lock wire recess (422), which may keep the lock wire from further retracting without sufficient
force. To release the lock wire (424), the user may apply a proximal force (e.g., via a control)
sufficient to straighten the bend (426).
[0089] As mentioned above, the snare may have a fixed distal portion that may be releasable from
a tip attached to the elongate body, or from a side wall of the elongate body, and retractable through
25WO 2017/147519 PCT/US2017/019495
a lumen of the elongate body. FIGS. 5A and 5B are perspective views of a distal portion of a
closure device (500) having a retractable snare. FIG. 5C is a top view of the closure device (500)
shown in FIG. 5A. As shown in FIG. 5A, the closure device (500) may comprise an elongate body
with a tip (503) and a snare loop assembly (501) at least partially extending from the tip (503). The
snare loop assembly (501) may comprise a snare comprising a proximal portion (512) and a distal
portion (514), and a suture loop (not shown) releasably coupled to the snare (512, 514), via, for
example, a retention member (not shown). A shuttle (516) may be connected to the distal portion
(514) of the snare and may be releasably coupled to the tip (503) of the elongate body. For
example, the tip (503) may comprise a shuttle recess (509) and an approximately L-shaped recess
(510) in a side wall of thereof. When the shuttle (516) is coupled to the tip (503), the shuttle (516)
may be positioned within the shuttle recess (509) and the distal portion (514) of the snare may be
positioned in the L-shaped recess (510).
[0090] As shown in FIG. 5B, the closure device (500) may comprise an elongate body (502)
comprising a tip (503) coupled to a distal portion of the elongate body (502). A snare loop
assembly may comprise a snare and a suture loop, although only a proximal portion (512) of the
snare and a distal portion (514) of the snare are shown in FIG. 5B. The proximal portion (512) of
the snare may extend from a first lumen (504) of the tip (503) to form a loop defining an aperture
that may be placed around tissue. When a suture loop comprises a suture knot (not shown), the
suture knot and a tail of the suture loop may be positioned in and/or extend through the second
lumen (506).
[0091] The proximal portion (512) of the snare may extend through the first lumen (504), where it
may be operatively connected to a handle assembly (not shown). The handle assembly may
advance and retract a proximal end of the snare (e.g., proximal to the proximal portion shown) to
control the size (e.g., diameter, circumference) of the aperture formed by snare loop assembly.
Since the suture loop (not shown) is coupled to the snare, movement of the proximal end of the
snare may move part of the suture loop into or out of the first lumen (504). Additionally, in
variations in which the suture loop is sized to have an amount of excess suture, some or all of the
26WO 2017/147519 PCT/US2017/019495
excess suture may be held or otherwise maintained in the first lumen (504) of the tip (503) or within
a lumen of the elongate body.
[0092] The tip (503) may additionally comprise a lock wire lumen (508) both distal and proximal
to the shuttle recess (509), and thus the shuttle (516) when the shuttle (516) is positioned within the
shuttle recess (509). The lock wire lumen (508) may be configured to secure the shuttle (516)
relative to the tip (503) when a lock wire (520) is extended through the tip (503) from the elongate
body, positioned through a window or lock wire recess (518) of the shuttle (516), and through the
lock wire lumen (508). The window (518) may also be open into the side of the tip (503), which
may allow a bend of the lock wire (520) to extend at least partially into the window (518) to resist
proximal movement of the lock wire (520) relative to the shuttle (516).
[0093] The proximal portion (512) of the snare may be operatively connected to a handle
assembly and a distal portion (514) of the snare may be connected to the shuttle (516). Generally,
the shuttle (516) may be a structure configured to couple the distal portion (514) of the snare to the
tip (503) of the closure device. The shuttle (516) may be coupled to the distal portion (514) of the
snare and may be releasably coupled to the tip (503) of the closure device, and may thus be
configured to fix the distal portion (514) of the snare relative to the tip (503). When the shuttle
(516) is coupled to the tip (503), the distal portion (514) of the snare is fixed relative to the tip
(503), and a proximal end (and the proximal portion (512)) of the snare may be advanced or
withdrawn (e.g., via a control such as a handle assembly) to open or close the snare and snare loop
assembly.
[0094] As shown in FIGS. 5A-5C, the distal portion (514) of the snare may be positioned in the
approximately L-shaped recess (510) when the shuttle (516) is coupled to the tip (503) (e.g.,
positioned in a shuttle recess (509) of the tip (503)). The approximately L-shaped recess (510) may
comprise a first surface (511) and a second surface (513) that is transverse to the first surface (511).
In some variations, the second surface (513) may be perpendicular (i.e., at an approximately 90
degree angle) to the first surface (511), while in other variations, the second surface (513) may be
angled away from the first surface (511). For example, the angle may be any suitable angle that
27WO 2017/147519 PCT/US2017/019495
prevents interference of the second surface (513) with the distal portion (514) of the snare and does
not otherwise interfere with or breakthrough the second lumen (506). For example, the angle
between the first and second surfaces (511, 513) may be an obtuse angle, for example, about 100
degrees, about 105 degrees, about 110 degrees, between about 90 degrees and about 105 degrees,
between about 95 degrees and about 110 degrees, or the like. In some variations, the second surface
(513) may form a shelf on which at least a portion of the distal portion (514) of the snare may rest
without being confined. The L-shaped recess (510) may be configured such that the distal portion
(514) of the snare positioned in the recess (510) may bend freely away from the tip (503) (e.g., a
longitudinal axis of the tip). In this way, the snare loop assembly may be transitioned from an open
configuration to a closed configuration and vice versa without being constrained by the surfaces of
the recess (510).
[0095] Utilizing a recess (510) with first and second surfaces (511, 513) that are perpendicular or
form an obtuse angle relative to one another may provide a number of advantages compared with
conventional U-shaped recesses. For example, conventional U-shaped recesses do not allow a distal
portion of a snare to bend freely and are thus prone to interference, misalignment, and tissue
pinching. In contrast, as the distal portion (514) of the snare is able to bend and move away from a
central longitudinal axis of the tip (503) without being constrained by the surfaces of the recess
(510), the distal portion (514) does not encounter interference from the tip (503) or shuttle (516).
Thus, frictional forces and/or an obstruction that may otherwise force the shuttle (516) to tilt up and
out of the tip (503) and create misalignment between the lock wire lumens of the tip (503) and the
shuttle (516) are minimized or prevented. Accordingly, utilizing the described recess (510) may
prevent or minimize interference between the surfaces of the recess (510) and the distal portion
(514) of the snare, which may make the closure device easier to manufacture by providing better
and more consistent alignment of the lock wire lumen openings. Additionally, utilizing the
described recess (510) may prevent or minimize tissue from becoming caught or pinched between
the tip (503) of the elongate body and the distal portion (514) of the snare positioned in the recess
(510). In particular, because the distal portion (514) of the snare may bend freely without
interference from the tip (503), pinching of tissue between the distal portion (514) and the tip (503)
28WO 2017/147519 PCT/US2017/019495
may be substantially reduced. Accordingly, both the ease of use of the closure device during a
procedure and the assembly of the closure device may be improved as alignment and fit of the
retractable snare is improved.
[0096] In another variation, the recess may be in the form of a channel comprising an increasing
width from the front surface of the shuttle recess to the front surface of the tip. For example, in
these variations, a proximal portion of the channel adjacent to or at the shuttle recess (e.g., aligned
with the front surface of the shuttle recess) may be narrower than a distal portion of the channel
adjacent to or at the distal end of the tip (e.g., aligned with the front surface of the tip). Thus, the
recess may be in form of a tapered channel. Utilizing a recess with increasing width distally along a
longitudinal axis of the tip (502) may assist in holding the shuttle (516) within the shuttle recess
(509) but may still allow the distal portion (514) of the snare to bend freely (e.g., without being
constrained by the walls of the recess).
[0097] FIG. 5C shows a top view of the tip (503) with a shuttle recess (509) in which the shuttle
(516) may be positioned. As shown, the lock wire (520) may be positioned within the lock wire
lumen and the window or lock wire recess (518) of the shuttle (516). The distal portion (514) of the
snare may be in contact with the first and second surfaces (511, 513) of the recess (510) of the tip
(503) and otherwise unencumbered to allow the distal portion (514) to be manipulated without
interference or contact from the tip (503). When the shuttle (516) is coupled to the tip (503) of the
elongate body within the shuttle recess (509), a clearance between the shuttle (516) and the tip (503)
may be about 0.004 inches (0.102 mm) total. For example, in some variations, the shuttle may have
a width of about 0.060 inches + .001/ -.002 inches (1.524 mm + 0.0254/ -0.0508 mm) and a length
of about 0.183 inches ± 0.003 inches (4.648 mm ± 0.0762 mm) and the shuttle recess (509) may
have a width of about 0.070 inches ± 0.003 inches (1.778 mm ± 0.0762 mm) and a length of about
0.190 inches ± 0.003 inches (4.826 mm ± 0.0762 mm), which may result in a shuttle clearance of
between about 0.003 inches (0.0762 mm) and about 0.0075 inches (0.1905 mm) on each side of the
shuttle, and a shuttle clearance of between about 0.0005 inches (0.0127 mm) and about 0.0065
inches (0.1651 mm) at the proximal and distal ends of the shuttle. In some variations, the shuttle
29WO 2017/147519 PCT/US2017/019495
clearance on each side of the shuttle may be about 0.005 inches (0.127 mm) and the shuttle
clearance on each of the proximal and distal ends may be about 0.0035 inches (0.0889 mm).
Shuttle
[0098] As described above, in some variations, a shuttle may be provided in a snare loop
assembly (e.g., coupled to a distal portion or end of the snare) to allow a distal portion of a snare
loop to be released from a tip of the elongate body and retracted into a lumen of the tip and/or
elongate body. While a diameter of the snare may generally be smaller than a diameter of a tip or
elongate body lumen, and thus may pass easily into the lumen, one disadvantage of other shuttle
configurations is their inability to retract into a lumen, thus preventing retraction of the snare into a
tip and/or elongate body. Consequently, when using devices with other shuttle configurations, the
shuttle and the snare loop attached thereto are at risk of being caught on anatomical features and the
deployed suture as the closure device is retracted from the target tissue.
[0099] In contrast to other devices, the closure devices described herein may comprise a shuttle
that is configured to fit through a lumen in the tip and/or elongate body. For example, a device for
closing a target tissue may comprise an elongate body comprising a lumen therethrough, a snare
loop assembly comprising a snare and a suture loop releasably coupled to the snare, and a shuttle
connected to a distal portion of the snare and releasably coupled to the elongate body that may
comprise a configuration to fit into the lumen of the elongate body. Put another way, the shuttle
may be configured to retract into a lumen of the tip and/or the elongate body.
[0100] For instance, after a shuttle is released from the tip of the elongate body (e.g., from a
shuttle recess in the tip), the snare loop and the shuttle may be partially or completely retracted into
the closure device such that the no portion of the snare or shuttle extends out of the lumen or only a
small portion of the snare and/or shuttle extends out of the lumen. In some variations, the closure
device may be configured such that the entirety of the snare and the shuttle may be retracted into a
lumen of the tip and/or elongate body, while in other variations, the closure device may be
configured such that the snare partially retracts into the lumen such that all or a portion of the
shuttle remains outside of the tip/elongate body (i.e., is not retracted into the lumen). This partial or
30WO 2017/147519 PCT/US2017/019495
full retraction reduces the likelihood of tissue pinching and/or catching on the deployed suture.
Additionally, partial or full retraction of the snare also reduces the risk of the snare being caught on
anatomical features. In this manner, the closure devices described herein may be retracted from the
target tissue and removed from the body more safely.
[0101] As mentioned above, in some variations, the closure devices described here may comprise
a shuttle that is configured to partially retract into a lumen of the tip and/or elongate body of the
closure device. For example, FIG. 18 is a perspective view of a variation of a closure device (1800)
having a partially retracted snare. The closure device (1800) may comprise an elongate body (1801)
comprising a tip (1802), a first lumen (1804), and a second lumen (1806), a shuttle (1816), and a
snare (1814) (only a distal portion of the snare is depicted). The shuttle (1816) may be connected to
the distal portion of the snare (1814). Although not depicted in FIG. 18, the snare (1814) may be
releasably coupled to a suture loop, for example, via a retention member, before deployment of the
suture loop. When the suture loop comprises a suture knot (not shown), the suture knot and a tail of
the suture loop may be positioned in and/or extend through the second lumen (1806). The tip
(1802) may additionally comprise a lock wire lumen (1808) that may be configured to receive a
lock wire that may secure the shuttle (1816) relative to the tip (1802) and the elongate body (1801).
The tip (1802) may comprise a shuttle recess (1812), in which the shuttle (1816) may be positioned
and housed when the shuttle (1816) is coupled to the tip (1802). The tip (1802) may further
comprise an approximately L-shaped recess (1810) in a side wall of the tip (1802).
[0102] In the variation shown in FIG. 18, the snare (1814) may be fully or partially retractable
into the first lumen (1804), while the shuttle (1816) may be partially retractable into the first lumen
(1804). For example, the diameter of the snare may be smaller than a diameter of the first lumen
(1804), and a maximum transverse dimension (transverse to the longitudinal axis of the snare) of at
least a portion of the shuttle (1816) (e.g., a height, width, or a diameter) may be larger than the
diameter of the first lumen (1804). For example, the shuttle (1816) may comprise a first proximal
portion (1815) coupled to the distal portion of the snare (1814) and a second distal portion (1817).
In some variations, the first proximal portion (1815) may have a maximum transverse dimension
that is smaller than a diameter (and/or height/width) of the first lumen (1804) and the second portion
31WO 2017/147519 PCT/US2017/019495
(1817) may have a maximum transverse dimension that is larger than the diameter (and/or height/
width) of the first lumen (1804). In other variations, the first portion of the shuttle (1816) may have
a smaller cross-sectional area than a cross-sectional area of the first lumen (1804), while the second
portion of the shuttle (1816) may have a larger cross-sectional area than the cross-sectional area of
the first lumen (1804), such that the second portion of the shuttle (1816) may not fit within the first
lumen (1804). In yet other variations, the second portion of the shuttle (1816) may comprise a
width that is larger than the diameter (or width) of the first lumen (1804), which may prevent the
second portion of the shuttle from being retracted into the first lumen (1804). Thus, in some
variations, the distal portion of the snare (1814) may be partially (as shown) or fully retracted into
the first lumen (1804), while the shuttle (1816) may only be partially retracted into the first lumen
(1804) (or in some variations, remain fully exposed but positioned closer to/just distal of a distal end
of the elongate body/tip).
[0103] In other variations, as will be described in detail herein, the closure devices described here
may comprise a shuttle that is sized and shaped to fully retract into a lumen of the tip and/or the
elongate body of the closure device. In these variations, a maximum transverse dimension of the
shuttle may be less than a diameter (and/or height/width) of the lumen of the tip and/or elongate
body. For example, FIGS. 9A and 9B are perspective views of a variation of a shuttle that is
configured to fully retract into a lumen of the tip and/or the elongate body. As described above, the
shuttle may be connected to a distal portion of the snare and may be releasably coupled to the tip of
the elongate body. The shuttle (900) may comprise a first lumen (902, 910), a second lumen (904),
a window or lock wire recess (906), and a projection (908). The first lumen (902, 910) may
comprise a lock wire lumen with a distal portion (902) and a proximal portion (910) separated by
the lock wire recess (906). A lock wire (not shown) may be advanced through or otherwise
disposed in the lock wire lumens (902, 910) and the lock wire recess (906) to releasably couple the
shuttle (900) to the elongate body. The projection (908) may be configured to engage with a
corresponding track in a shuttle recess of a tip (e.g., track (416) of a shuttle recess (408)). This
engagement may minimize rotation of the shuttle (900) relative to the tip when external forces are
applied to the snare loop.
32WO 2017/147519 PCT/US2017/019495
[0104] A user may use the closure device to pull the shuttle (900) into a lumen of the elongate
body when the snare is fully retracted. The shuttle may comprise a configuration to fit into the
lumen. The shuttle may comprise various sections or portions with different characteristics, for
example, different diameters, cross-sectional areas, cross-sectional shapes, materials, and the like,
which may improve the fit and slidability of the shuttle in the lumen. For example, at least some
portions of a cross-section of the shuttle may correspond to the shape of the lumen. In some
variations, a radius of curvature of at least a portion of the shuttle may be the same as a radius of
curvature of the lumen. The shuttle may comprise any suitable length allowing the shuttle to be
releasably coupled to the elongate body and to fit into the lumen. The shuttle may also comprise
any suitable configuration to couple with a lock wire, such as a lock wire lumen and optionally a
window or lock wire recess. For instance, the shuttle (900) may comprise a lock wire recess (906)
comprising a width between about 0.015 inches (0.381 mm) and about 0.025 inches (0.635 mm).
[0105] FIG. 10 is a sectional view of a variation of a shuttle in a lumen of a tip of a closure
device. As mentioned above, in some variations, the shuttle (1000) may comprise a shuttle diameter
that is less than a diameter of a lumen (1010) of the tip (e.g., the first lumen (1804) in FIG. 18).
This configuration allows the shuttle (1000) to fully retract into the lumen when the snare is fully
retracted. For example, in one variation, the shuttle (1000) may comprise a radius between about
0.015 inches (0.381mm) and about 0.030 inches (0.762 mm). In some variations, the shuttle (1000)
may comprise a radius of about 0.030 inches (0.762 mm). In these variations, the lumen may
comprise a radius of about 0.031 inches (0.80 mm), and thus, the radius of the shuttle (1000) may be
less than the radius of the lumen (1010). In these variations, the shuttle (1000) retracted into the
lumen (1010) has a clearance fit. A clearance fit may be a positive difference between a size of the
lumen (e.g., diameter, height, width) and a size of the shuttle (e.g., a dimension (height, width,
diameter) of the largest portion of the shuttle). In other variations, the shuttle diameter may be
equal to the diameter of the lumen (1010) and or may be slightly larger than the diameter of the
lumen (1010), but the shuttle may be configured to compress or otherwise decrease in size in order
to fit within the lumen (1010).
33WO 2017/147519 PCT/US2017/019495
[0106] The shuttle (1000) may comprise a first lumen (1002), a second lumen (1004), and a
projection (1008). The second lumen (1004) may comprise a snare lumen where FIG. 10 illustrates
a distal portion of the snare lumen. The snare lumen may house a portion of the snare such that the
shuttle (1000) is coupled to a distal portion of the snare. A proximal portion of the second lumen
(1004) may comprise an offset obround shape (1006) and a distal portion of the second lumen may
comprise a circular shape. In one variation, a proximal portion of the snare lumen comprises an
offset obround shape. An end of the snare may comprise a flattened portion (not shown) configured
to fit within the obround shape (1006). In these variations, the use of a lumen with obround and
circular portions may assist in preventing the flattened portion of the snare from pulling out of or
breaking through the second lumen (1004) (e.g., from the obround portion to the circular portion)
and coming out of the shuttle (1000). The flattened portion may further be bonded to the obround
shape (1006) to prevent the snare from pulling through the second lumen (1004) as well as
preventing the snare from rotating relative to the shuttle. The obround shape (1006) may be filled
with adhesive, such as epoxy, to bond the flattened portion of the snare to the shuttle (1000). The
first lumen (1002) may comprise a lock wire lumen and may be sized and shaped for passage of a
lock wire therethrough. In some variations, the diameter of the lumen (1010) of the elongate body
may be equal to or less than about 0.063 inches (1.60 mm). The shuttle diameter may be equal to or
less than about 0.061 inches (1.56 mm).
[0107] The shuttle may be formed from any suitable material or materials, such as, for example,
one or more metals (e.g., stainless steel), one or more rigid plastics, one or more polymers, or the
like. In some variations, the shuttle may be formed from the same material or materials as a portion
of the tip or elongate body, but need not be. In some variations, the shuttle may be formed from one
or more of polyetherimide (e.g., Ultem®), polycarbonate, and stainless steel.
Handle
[0108] As described above, the closure devices described here may comprise a handle or other
control mechanism. The handle may have any suitable shape or configuration, for example, any of
those described in U.S. Patent Application No. 12/752,873, entitled “Tissue Ligation Devices and
34WO 2017/147519 PCT/US2017/019495
Controls Therefor” and filed on April 1, 2010, which was previously incorporated by reference, or
U.S. Patent Application No. 14/195,797, entitled “Tissue Ligation Devices and Methods Therefor”
and filed March 3, 2014, the entire content of which is hereby incorporated by reference herein.
[0109] The handle may serve many purposes. Of course, the handle may provide an interface
between the device and the user as the user may hold onto and control the device and its
components using the handle. The handle may be used to control and actuate the snare loop
assembly through the elongate body, guide the elongate body, and/or modify the shape of the
elongate body using a pull wire controlled through the handle. The handle may enable a user to
control the release of the suture loop from the closure element, and in variations in which a
visualization tool is used, it may be used to house electronic or other components for the
visualization tool. The handle may comprise any suitable elements to facilitate use of the device for
the closure of tissue, including sliders, knobs, switches, latches, push buttons, and the like, which
may be coupled to any component of the snare loop assembly to pull, push, open, close, deploy, or
otherwise use the component.
[0110] In some embodiments, the handles of the closure devices described here may comprise a
tensioning mechanism for managing the tension applied to a portion of the suture loop (e.g., a tail of
the suture loop) of the closure device. When the closure devices are used to place and tighten a
suture loop around a tissue, it may be desirable to manage the tension applied to the suture as the
suture loop is tightened.
[0111] When the closure devices described comprise a snare that is temporarily fixed to the
elongate body via a shuttle and a lock wire, the handle may comprise a mechanism that allows for
withdrawal of the lock wire, and the lock wire may be withdrawn in any suitable manner. Current
solutions do not provide a mechanism for full retraction of the snare and optionally the shuttle with
safeguards that prevent premature retraction of the snare loop initiated by user error. The handle
assembly and variations described in detail below allow a shuttle and snare loop to be fully retracted
through or into the tip and/or the elongate body in a desired order that may assist in preventing user
error. For example, a device for closing a target tissue may comprise an elongate body, a snare loop
35WO 2017/147519 PCT/US2017/019495
assembly comprising a snare and a suture loop releasably coupled to the snare, a shuttle configured
to releasably couple to the elongate body, and a handle comprising a lock or a snare control with a
limiter, which of which may be configured to limit movement of the snare control along a track.
[0112] FIGS. 11 A-l IB and 1 ID-1 IE are perspective views of an illustrative variation of a handle
assembly for use with the closure devices described here. A handle (1104) of the handle assembly
(1100) may be attached to the elongate body (1102). The handle (1104) may comprise a snare
control (1106) configured to control movement of the snare (not shown), a track (1108), which may
be formed on a side, top, or bottom thereof, and a lock (1110). The handle assembly (1100) may
further comprise a suture control (1112) configured to tighten the suture loop. The suture control
(1112) may be releasably coupled to the handle (1104) via a first opening (1118) and a second
opening (1120). The snare control (1106) may comprise a slider and may be coupled to and
slideably disposed within or on the track (1108). The track (1108) may comprise a first portion
(1109) and a second portion (1116), and the lock (1110) may be configured to limit movement of
the snare control (1106) along the second portion (1116) of the track. The device may be
configured such that the snare control (1106) may freely move/slide along the first portion (1109) of
the track to open or close a snare loop assembly regardless of whether the lock (1110) is engaged
(i.e., when the lock is engaged and when the lock is disengaged), but may be prevented from
moving/sliding along the second portion (1116) of the track when the lock (1110) is engaged. The
handle (1104) may further comprise a side opening (1114) aligned with at least a portion of the
second portion (1116) of the track.
[0113] The lock (1110) may physically limit retraction of the snare prior to release of the shuttle
from the elongate body (1102). For example, the lock (1110) may comprise a stopper (1115) that
extends along a length of the track. For example, the stopper (1115) may fit over and/or within the
second portion (1116) of the track and may prevent the snare control (1106) from moving along or
within the second portion (1116) of the track. In some variations, the stopper (1115) may comprise
a rectangular plate that covers the second portion (1116) of the track, while in other variations, the
stopper may comprise a cylindrical or other shaped element that fits within, covers, or otherwise
36WO 2017/147519 PCT/US2017/019495
blocks the track and/or prevents the snare control (1106) from moving proximally along the second
portion (1116) of the track.
[0114] Additionally, in some variations, the lock (1110) may further comprise a release
engagement portion (1111) configured to limit movement of the snare control (1106) along a second
portion (1116) of the track (1108) until after release of the suture. In these variations, the release
engagement portion (1111) may releasably couple to a release assembly within the handle. The
release assembly may be configured to release a shuttle (not shown) from the elongate body (1102)
and may hold the lock (1110) in position in or on the track (1108) until after release of the suture, as
will be described in more detail below. In some variations, the release engagement portion (1111)
may comprise a protrusion that may extend from the underside (e.g., bottom surface) of the stopper
(e.g., at an approximately 90 degree angle) and may comprise an opening (1113) that may
releasably couple to a portion of the release assembly.
[0115] FIG. 11A depicts a lock (1110) covering the second portion (1116) of the track (1108),
which limits movement of the snare control (1106) along the second portion (1116) of the track
(1108). FIG. 1 IB depicts the lock (1110) removed from the second portion (1116) to allow
movement of the snare control (1106) along the second portion (1116) of the track (1108). FIG.
11C is a top view of the handle assembly shown in FIG. 1 IB. FIG. 1 ID illustrates the snare control
(1106) moved along the track (1108) to a position adjacent the second portion (1116). FIG. 1 IE
illustrates the snare control (1106) moved to a proximal end of the track (1108). The snare control
(1106) is configured to retract the snare and the shuttle into the elongate body (1102) when the snare
control (1106) moves along the second portion (1116) of the track (1108), such as to the proximal
end of the track (1108).
[0116] A proximal portion of the suture control (1112) may be configured to engage the release
assembly through the opening (1114) in the handle to release the lock (1110) from the track (1108)
and allow movement of the snare control (1106) along the second portion (1116) of the track
(1108). Additionally, or alternatively, the suture control (1112) may be configured to engage the
release assembly to retract a lock wire that releasably couples the shuttle to the elongate body
37WO 2017/147519 PCT/US2017/019495
(1102). Additionally, or alternatively, the suture control (1112) may be configured to engage the
release assembly to release the shuttle from the elongate body (1102). In some variations, the
closure device may be configured such that when the suture control (1112) engages the release
assembly, the lock (1110) is released and the lock wire is simultaneously retracted, thereby
releasing the shuttle from the elongate body (1102). Thus, in some variations, the lock (1110) may
be released from the track (1108) and thus the handle (1104) and the shuttle may be released from
the elongate body simultaneously.
[0117] FIG. 12 shows a perspective view of a suture control (1200) for use with a handle
assembly such as the handle assembly (1100) described with respect to FIGS. 11 A-l ID. The suture
control may comprise a body (1202) configured to be gripped or held by a hand of a user and one or
more projections. For example, the suture control may comprise a first, longer, elongate portion
(1204) that may be inserted into a handle, and a second, shorter, elongate portion (1206) that may be
coupled to the suture. The first portion (1204) may be longer than the second portion (1206) such
that when the first portion is inserted into a side opening in the handle (for example, the side
opening (1114) depicted in FIG. 11 A), the second portion (1206) does not interfere or otherwise
prevent the first portion (1204) from engaging the release assembly. Additionally, the first portion
(1204) may comprise a diameter that is smaller than the diameter of the side opening, such that the
first portion (1204) may be advanced through the side opening to engage the release assembly. In
other variations, the suture control (1200) may comprise a single projection or elongate portion that
may both couple to the suture to release the suture from the snare loop assembly and/or tighten the
suture, and be inserted into a side opening in the handle to engage with a release assembly (e.g., to
release the shuttle and unlock the lock). The suture control (1200) may also couple to a distal end
surface of the handle (e.g., through insertion of the one or more projections through openings in the
distal end surface), as depicted in FIG. 11 A. Additionally, while the suture control (1200) is
depicted with cylindrical projections, the one or more projections may have any suitable cross-
sectional shape, for example, oval, square, rectangular, hexagonal, and the like.
[0118] FIGS. 13A-13B are cross-sectional perspective views of a variation of a handle assembly
(1300) of a closure device. A bottom cover of the handle (1302) is not shown in FIGS. 13A-13B in
38WO 2017/147519 PCT/US2017/019495
order to illustrate an underside of the inner portion of the handle assembly (1300), such as the
underside of the track (1308) and the lock (1310). The handle (1302) may comprise an opening
(1304) to guide at least a portion of a suture control (not shown) into the handle (1302) to engage
with a release assembly (1320). As described above with respect to FIGS. 11 A-l ID, movement of
the snare control along the track (1308), for example, a second portion of the track, may be limited
by the lock (1310) when the lock is coupled to the handle and positioned on or within the track
(1308). The handle (1302) may further comprise a release assembly housing (1316) and a release
assembly housing track (1318) which define the path of movement for the release assembly (1320)
and guide the release assembly (1320) along a linear path laterally toward an opposite side of the
handle when a portion of the suture control engages with the release assembly (1320).
[0119] As shown in FIG. 13 A, the lock (1310) may comprise an end plate (1312) at a proximal
end thereof and a lock engagement portion (1314). The lock engagement portion (1314) may
comprise an opening configured to receive at least a portion of a release engagement portion.
Insertion of at least a portion of the suture control into the opening (1304) may unlock the lock
(1310) from the track (1308) by disengaging the lock engagement portion (1314) from a portion of
the release assembly (1320) (e.g., the release engagement portion). Insertion of at least a portion of
the suture control into the opening (1304) may also pull the lock wire proximally, which may retract
the lock wire from the lock wire lumen in the shuttle and release the shuttle from the elongate body.
The unlocked lock (1310) may be manually removed from the track (1308), which may clear the
second portion of the track so that the snare control may move along a second portion of the track
(1308). The end plate (1312) may comprise an L-shaped structure that may be configured to
couple to a notch or channel (1309) in the track (1308).
[0120] The release assembly (1320) may comprise a release engagement portion (1324)
configured to releasably couple to the lock engagement portion (1314) of the lock (1310). When the
release engagement portion (1324) is coupled with the lock engagement portion (1314), movement
of the snare control may be limited, as the lock may block or otherwise prevent the snare control
from moving along or through the second portion of the track. Thus, when the release engagement
39WO 2017/147519 PCT/US2017/019495
portion (1324) is coupled with the lock engagement portion (1314), the snare and shuttle may not be
fully retracted into a lumen of the tip and/or the elongate body.
[0121] In some variations, the release engagement portion (1324) may comprise a base (1323)
and a protrusion (1325) that extends therefrom, and the protrusion (1325) may be configured (e.g.,
sized and shaped) to fit within an opening in the lock engagement portion (1314). In some
variations, the protrusion (1325) may comprise a circular cross-sectional shape, and a diameter of
the protrusion (1325) may be less than the length/width/diameter of the base (1323), however, the
length or height of the protrusion (1325) may be greater than a height of the base (1323). The base
(1323) may have any suitable cross-sectional shape, for example, square, rectangular, circle, oval,
and the like. In other variations, the release engagement portion (1324) may comprise an elongate
member comprising a circular cross-sectional shape without a discrete or discemable base. The
diameter of the elongate member may be constant along the longitudinal axis of the elongate
member (e.g., from a proximal to a distal end of the elongate member). In these variations, the
elongate member and/or the entire engagement portion (1324) may be configured to fit within an
opening of the lock engagement portion (1314). In some variations, the protrusion (1325) and/or
the entire release engagement portion (1324) may have a non-circular cross-sectional shape, for
example, square, rectangular, oval, hexagonal, octagonal, or the like. In some embodiments, the
release engagement portion (1324) may comprise one or more notches, grooves, and/or indentations
on an external surface thereof (e.g., along a length and/or around a circumference thereof), which
may in some instances assist with establishing or maintaining contact between the release
engagement portion (1324) and the lock engagement portion (1314) of the lock (1310). In
variations comprising a base and a protrusion, the notches, grooves, and/or indentations may be on
the on the protrusion (1325) and optionally on the base (1323).
[0122] The release assembly (1320) may also comprise a lock wire engagement portion (1322)
(e.g., a post around which the lock wire may be wound, a screw, or the like), which may couple a
proximal end of the lock wire to the release assembly (1320). As described above, the distal end of
the lock wire may be disposed within lock wire lumens in the shuttle and the tip or elongate body,
which may releasably couple the shuttle to the elongate body.
40WO 2017/147519 PCT/US2017/019495
[0123] FIG. 13A illustrates the release assembly (1320) prior to advancement of at least a portion
of a suture control through the opening (1304) in the handle (1302). Thus, the lock (1310) in FIG.
13 A is engaged and a user is prevented from retracting the snare control through the second portion
of the tract to retract the snare and shuttle into a lumen of the device. When the lock is engaged, the
stopper of the lock (1310) may be coupled to the track (1308) through the coupling of the lock
engagement portion (1314) of the lock (1310) and the release engagement portion (1324) of the
handle (1302). In this configuration, the end plate (1312) may also be coupled to the notch (1309)
in the track (1308).
[0124] FIG. 13B illustrates the handle assembly (1300) after the suture control has been advanced
through the opening (1304) and has engaged the release assembly (1320) to release the lock wire
and the lock (the lock has been removed for clarity). In particular, the release assembly (1320) has
been guided to a second end (opposite a first end adjacent to the opening (1304)) of the releasable
assembly housing track (1318) within the releasable assembly housing (1316) to uncouple the
release engagement portion (1324) from the lock engagement portion (1314) of the lock (1310).
Accordingly, the lock (1310) may be removed from the track (1308) to thereby allow movement of
the snare control along a second portion of the track (1308). The movement of the release assembly
(1320) along the release assembly housing (1316) also draws in the lock wire to release the shuttle
from the elongate body at a distal end of the closure device. Thus, in some variations, movement of
the snare control may be limited by the lock until the suture is released, the suture control is
decoupled (e.g., cut) from the suture, and at least a portion of the suture control is advanced through
the opening to engage (e.g., push, move in a direction transverse to the longitudinal axis of the
handle) the release assembly. Accordingly, in this way, premature retraction of a snare loop and the
shuttle (e.g., prior to release of the suture loop from the snare loop assembly and/or prior to release
of the shuttle from the elongate body) may be prevented. While it may be useful in some variations
to prevent release and retraction of the shuttle prior to release of the suture loop from the snare loop
assembly, the suture loop need not be deployed from the snare loop assembly prior to release and
retraction of the shuttle in all instances.
41WO 2017/147519 PCT/US2017/019495
[0125] FIGS. 14A and 14C are cross-sectional perspective views of another variation of a handle
assembly (1400) of a closure device. In this variations, in place of the lock (1310) shown in FIG.
13 A, the snare control (1412) may comprise a limiter (1416) configured to limit movement of the
snare control along the track (1404) until a suture control (1422) is inserted into the handle (e.g., via
a side opening). FIG. 14B is a cross-sectional side view of the handle assembly shown in FIG. 14A.
A bottom cover of the handle (1402) is not shown in FIGS. 14A, 14B, and 14C in order to illustrate
an underside of the inner portion of the handle assembly (1400), such as the underside of the track
(1404) and snare control (1412).
[0126] The handle (1402) may comprise an opening (not shown) to enable and guide a suture
control (1422) to engage with a release assembly (1418) within the handle (1402). The handle
(1402) may further comprise a release assembly housing (1406) to guide movement of the release
assembly (1418) along a release assembly housing track (1408) while the suture control (1422)
engages the release assembly (1418). The snare control (1412) may comprise a slider (1413), a
track engagement portion (1414) coupled to the slider (1413) via a spring and slideably coupling the
slider (1413) to the track (1404), a snare coupler (1415) (e.g., a bracket or the like) coupling a
proximal end of the snare to the snare track engagement portion (1414) of the snare control (1412),
and a limiter (1416) coupled to or formed integrally with a proximal portion of the snare track
engagement portion (1414) and configured to limit movement of the snare control along the track
(1404). The slider (1413) may be configured to be advanced and retracted by a hand of the user
(e.g., a thumb) when the device is in use.
[0127] The limiter (1416) may extend along a length of the handle (e.g., along a longitudinal axis
thereof) sufficient to provide retraction of the snare and shuttle into the elongate body through
movement of the snare control (1412) along the track (1404). The limiter (1416) may be provided
on a non-overlapping parallel plane with respect to the release assembly (1418) so as to allow the
limiter (1416) to travel over the release assembly (1418) (and the release assembly housing (1406)
when the slider (1512) is facing upward toward a user (under the release assembly in the
configuration shown) when disengaged from the release assembly (1418), as shown in FIG. 15A.
42WO 2017/147519 PCT/US2017/019495
The release assembly (1418) may be configured to release the shuttle from the elongate body and
allow movement of the snare control (1412) along the track.
[0128] The suture control (1422) may be configured to tighten the suture loop and may comprise
a proximal portion. The proximal portion may be configured to engage the release assembly (1418)
through an opening in the handle and may comprise a projection (1424). When the projection
(1424) engages the release assembly (1418), the limiter (1416) may be disengaged from the release
assembly (1418). For instance, the release assembly (1418) may comprise an engagement portion
(1420) and the suture control (1422) may be configured to engage the release assembly (1418) to
disengage the limiter (1416) from the release assembly (1418), as shown in FIG. 14C. In particular,
the engagement portion (1420) may disengage from the limiter (1416) to allow movement of the
snare control (1412) along the track (1404). In some variations, disengaging the limiter (1416) may
comprise moving the engagement portion (1420) for example, in a direction transverse to a
longitudinal axis of the handle (1402), from a first location in which it blocks or otherwise prevents
proximal movement of the limiter (1416) to a second location in which it no longer blocks or
otherwise prevents proximal movement of the limiter (1416). In this variation, the engagement
portion (1420) may serve as a physical stop or barrier. Thus, engaging the release assembly (1418)
with at least a portion of the suture control (1422) may move the engagement portion (1420) out of
a pathway of the limiter (1416) such that the limiter (1416) may move to a location proximal of the
engagement portion (1420). In the variation shown in FIG. 14C, the engagement portion (1420) is
disengaged from the limiter (1416) and may be positioned in another opening in the handle (1402).
[0129] The suture control (1422) configured to engage the release assembly (1418) may release
the shuttle from the elongate body. In some variations, the suture control (1422) may
simultaneously disengage the engagement portion (1420) of the release assembly (1418) from the
limiter (1416) and release the shuttle from the elongate body.
[0130] The handle (1402) may further comprise a flexible latch (1410) configured to allow
movement of the release assembly (1418) during insertion of the suture control (1422) into the
handle (1402), and configured to limit movement of the release assembly after engagement of the
43WO 2017/147519 PCT/US2017/019495
suture control (1422) to the release assembly (1418). As shown in FIG. 14A, as the suture control
(1422) is inserted into the handle (1402), the flexible latch (1410) may engage the release assembly
(1418) and bend enough to allow the release assembly (1418) to be pushed to an end of the release
assembly housing track (1408). However, as shown in FIG. 14C, upon completed insertion of the
projection (1424) into the opening, the flexible latch (1410) may return to its original position and
engage with a first side surface (i.e., a surface closest to the opening in the handle through which the
suture control (1422) is inserted) of the release assembly (1418) in such a manner as to prevent the
release assembly (1418) from reverse movement along the release assembly housing track (1408)
towards the opening.
[0131] FIG. 15A is a cross-sectional perspective view of a variation of a handle assembly (1500)
of a closure device. FIG. 15B is a cross-sectional side view of the handle assembly shown in FIG.
A. FIGS. 15A-15B illustrate the movement of the snare control (1512) to an end of the track
(1504) after engagement of the suture control (1522) disengages the release assembly (1518) from
the limiter (1516) of the snare control (1512). The suture control (1522) need not remain in the
handle (1502) once inserted, and is provided in FIGS. 15A-15B merely for illustrative purposes.
[0132] The snare control (1512) may comprise a slider (1513) or other element configured to
interface with a user, a track engagement portion (1514) slideably coupling the snare control (1512)
to the track (1504), a snare coupler (1515), and a limiter (1516). The suture control (1522) may
comprise a projection (1524) insertable into an opening (not shown) of the handle (1502), which
may engage with the release assembly (1518). The handle (1502) may comprise a release assembly
housing (1506) that may guide the release assembly (1518) along a housing track (not shown) as the
suture control (1522) is inserted into the housing (1502) via the opening. An engagement portion
(1520) is shown disengaged from the limiter (1516) to allow movement of the snare control (1512)
along the full length of the track (1504). Additionally, the handle (1502) may also comprise a latch
(1510) similar to the latch (1410) described above with respect to FIGS. 14A-14C.
44WO 2017/147519 PCT/US2017/019495
II. Methods
[0133] The closure devices described here may be useful for closing tissue, for example, the left
atrial appendage. The closure devices may access the left atrial appendage using percutaneous or
surgical techniques (e.g., median sternotomy, mini sternotomy, thoracotomy, thoracoscopy). One or
more guides having alignment members may be advanced to the left atrial appendage. These guides
may be any suitable guide, such as those described in U.S. Patent No. 8,771,297, entitled “Devices,
Systems, and Methods for Closing the Left Atrial Appendage” and filed on March 25, 2008, which
is incorporated by reference herein in its entirety. For example, first and second guides having
alignment members may be used to guide the procedure. The alignment members may be any
suitable alignment members (e.g., interconnecting elements, one or more vacuum members,
radiopaque or echogenic markers, members that are configured to produce an audible response,
magnets, and the like). In some variations, the alignment members may be magnets located at the
distal ends of the guides. These guides may be used for guiding additional tools and/or devices
(e.g., the closure device) to the left atrial appendage.
[0134] For example, in some variations, a first guide may be advanced into the left atrial
appendage, while the second guide may be advanced into the pericardial space adjacent to the left
atrial appendage. Either of these guides may be advanced under any of a variety of visualization
techniques, such as fluoroscopic visualization, ultrasound visualization, or some combination
thereof. Once the first and second guide members have been advanced to the left atrial appendage,
one or more positioning and/or stabilizing elements (e.g., balloons or other expandable structures)
may be advanced over or in conjunction with the first guide (e.g., it may be coupled to or be part of
the first guide) and into the left atrial appendage. Similarly, a closure device may be advanced over
the second guide to the exterior of the left atrial appendage. It should be appreciated that the closure
device may be any of the closure devices described above.
[0135] When placed in the left atrial appendage, the positioning element may be used to help
position the snare loop of the closure device. In some variations, an expandable structure may be
inflated or otherwise expanded in or near the opening of the left atrial appendage and the snare loop
45WO 2017/147519 PCT/US2017/019495
may be closed around the left atrial appendage distal to the expandable structure. In other
variations, the expandable member may be expanded inside of the left atrial appendage. In these
variations, the expandable member may help position the closure device near the base of the left
atrial appendage.
[0136] While the expandable member is in an expanded state, the snare loop may be opened and
may be placed around a portion of the left atrial appendage. Once placed around the left atrial
appendage, the snare loop may be closed around the left atrial appendage.
[0137] A distal end of an elongate body may be advanced into the body toward a target tissue
(e.g., the left atrial appendage). During advancement, the snare loop assembly may be in a closed
configuration to help prevent the snare loop assembly from snagging or catching on tissue or other
obstructions. Once the distal end of the elongate body has reached a location at or near the target
tissue, the snare loop assembly may be opened to a deployed configuration. The snare loop
assembly may then be advanced, moved, or otherwise manipulated to encircle at least a portion of
the target tissue. The snare loop assembly may then be closed around the encircled tissue to close,
ligate, or otherwise restrict the target tissue. The snare loop assembly may be re-opened,
repositioned, and re-closed as necessary.
[0138] In some instances, a suture loop or other restricting device may be tightened and released
from the closure device to maintain the target tissue in a closed fashion. To remove the closure
device from the body, the snare loop assembly (e.g., the snare and optionally a retention member)
may again be opened to release the target tissue (the suture loop or other restricting device may
remain in place) such that the snare loop assembly and the elongate body may be withdrawn. The
snare loop assembly may be released for retraction into the elongate body. In variations where the
closure device comprises a retraction device or mechanism, the retraction device or mechanism may
be used to release the snare and shuttle from the elongate body and retract the snare and shuttle into
the elongate body.
[0139] In some variations using the devices described here, the methods may comprise fully
retracting the snare and shuttle into the elongate body such that no portion, or just a small portion,
46WO 2017/147519 PCT/US2017/019495
of the snare and the shuttle remain exposed outside the elongate body. The methods described
herein may ensure the release of the suture loop from the snare and retraction of the snare and
shuttle from the tip in a manner that prevents an operator from prematurely retracting the snare and
shuttle prior to releasing the shuttle from the tip. FIGS. 16A-16G and 17A-17G may more clearly
demonstrate these concepts. In FIGS. 16A-16G, a shuttle is released and retracted before tightening
a suture loop. In FIGS. 17A-17G, a shuttle is released and retracted after tightening a suture loop.
[0140] FIG. 16A is a flowchart (1600) for one variation of a tissue closing process using the
devices described herein. FIGS. 16B-16G are perspective views of a snare loop assembly and
handle corresponding to the various steps in FIG. 16A. The flowchart (1600) begins with
advancement of a closure device towards target tissue (1602). Once advanced to a desired position,
a snare loop assembly may be closed around the target tissue (1604), as illustrated in FIGS. 16B and
16C. FIG. 16B illustrates an elongate body (1620) comprising a tip (1622), and a snare loop
assembly (1624) comprising a shuttle (1626) positioned within a shuttle recess of the tip (1622).
While the snare loop assembly (1624) is depicted without a suture loop and a retention member, the
snare loop assembly may comprise both a suture loop and a retention member. The snare loop
assembly (1624) is illustrated in the closed position, and the position of the snare loop assembly
(and the size of the aperture formed by the snare loop assembly) may be modified by user operation
of the handle (1628) shown in FIG. 16C. The snare control (1630) may slide along a track, but may
be prevented from initiating retraction of the snare loop assembly (1624) and the shuttle (1626) into
the elongate body (1620) and/or tip (1622) by a lock (1632) as depicted (and described in more
detail with respect to FIGS. 11 A-l ID and 13A-13B), or a limiter as described in more detail with
respect to FIGS. 14A-14B and 15A-15B. The snare loop assembly (1624) may be opened and
closed as necessary to ensure that the target tissue is properly ligated. The handle (1628) may
further comprise a suture control (1634) for tightening a suture loop, releasing the lock (1632) from
the track, and/or releasing the shuttle (1626).
[0141] After the snare loop assembly (1624) is determined to be positioned properly relative to
the target tissue and is closed around the target tissue, the suture loop (not depicted) may be released
(1606) from the snare loop assembly (1624). A user may pull the suture control (1634) out from a
47WO 2017/147519 PCT/US2017/019495
base of a handle (1628) in order to release the suture loop from the snare loop assembly (1624). As
least a portion of the suture control (1634) may then be inserted into an opening (e.g., a side
opening) in the handle (1628) to engage the release assembly within the handle (1628), release
(1608) the shuttle (1626) from the elongate body (1620), and unlock the lock (1632). FIGS. 16D
and 16E depict the shuttle released from the shuttle recess of the tip (1622) of the elongate body
(1620), and the lock (1632) unlocked and removed from the track. The shuttle (1626) and the
portion of the snare loop assembly (1624) remaining outside of the elongate body (1620) may then
be partially or fully retracted into the tip (1622) and the elongate body (1620).
[0142] In the illustrative variation of FIG. 16E, the shuttle (1626) may be released from the
elongate body (1620) by removing the suture control (1634) from the handle (1628) and inserting a
portion of the suture control (1634) into an opening in the handle in order to engage the inserted
portion of the suture control (1634) with a release assembly (not shown) provided within the handle
(1628). For example, as the suture control (1634) engages with or otherwise moves the release
assembly, a lock wire coupling the shuttle (1626) to the tip (1622) may retract, which may release
the shuttle (1626) from the tip (1622) of the elongate body (1620). The engagement of the suture
control (1634) with the release assembly may, in some variations, further simultaneously
release/unlock the lock (1632) or a limiter. Removal of the lock (1632) or disengagement of a
limiter may allow the snare control (1630) to move proximally further along a track of the handle
(1628). Movement of the snare control (1630) proximally to an end of the track may retract the
snare loop (e.g., the portion of the snare and retention member that remain outside of the elongate
body) and the shuttle into the lumen.
[0143] Next, FIGS. 16F and 16G illustrate retraction (1610) of the shuttle (1626) into the elongate
body (1620) such as into a lumen (1636) of the tip (1622) and/or a corresponding lumen in the
elongate body (1620). For example, in variations comprising a tip (1622), retraction of the shuttle
(1626) may result in a portion of the snare loop becoming positioned within a lumen of the elongate
body and a portion of the snare loop becoming positioned within a lumen of the tip (1622), or may
result in the entirety of the snare loop becoming positioned within a lumen of the elongate body
(1620). It should be appreciated that after the shuttle is released, the snare loop may no longer have
48WO 2017/147519 PCT/US2017/019495
a loop configuration. After retraction, the shuttle may be positioned within a lumen of the tip
(1622), within a lumen of the elongate body (1620), partially within the lumens of both the tip
(1622) and the elongate body (1620), or partially within the lumen of the tip (1622) and partially
extending from a distal end of the device. In variations in which a tip is not used, retraction of the
shuttle (1626) may result in the snare loop and the shuttle becoming positioned within a lumen of
the elongate body. Retraction of the snare loop assembly (1624) and the shuttle (1626) into the tip
(1622) and/or elongate body (1620) may be controlled by sliding the snare control (1630) along an
end portion (second portion) of the track previously covered by the lock (1632) or previously
blocked by the limiter. FIG. 16G shows the snare control (1630) at the end portion of the track
(e.g., at a proximal end of the track) to fully retract the shuttle (1626) and snare loop assembly
(1624) into the elongate body (1620) and tip (1622), and FIG. 16F depicts the snare loop and the
shuttle fully retracted into the lumen (1636) of the tip (1622) and/or a corresponding lumen in the
elongate body (1620).
[0144] Once the shuttle and snare are retracted into the elongate body, the suture loop may be
tightened, or further tightened, around the target tissue (1612) using, for example, any of the
tensioning devices described in U.S. Patent Application No. 13/490,919, entitled “Tissue Ligation
Devices and Tensioning Devices Therefor” and filed on June 7, 2012, the contents of which are
incorporated by reference herein in their entirety. Finally, the closure device may be withdrawn
from the body (1614). As illustrated in FIGS. 16A-16G, the snare loop assembly (1624) and the
shuttle (1626) may not be retracted until the shuttle (1626) is released from the tip (1622). In this
manner, premature retraction is prevented, thereby improving operability and safety of the closure
device.
[0145] FIG. 17A is a flowchart (1700) for another variation of a tissue closing process. FIGS.
17B-17G are perspective views of a snare loop assembly and a handle corresponding to the various
steps in FIG. 17A. The flowchart (1700) begins with advancement of a closure device towards
target tissue (1702). Once advanced to a desired position, a snare loop assembly may be closed
around the target tissue (1704).
49WO 2017/147519 PCT/US2017/019495
[0146] FIG. 17B illustrates an elongate body (1720) comprising a tip (1722), and a snare loop
assembly (1724) comprising a shuttle (1726) positioned within a shuttle recess of the tip (1722).
The snare loop assembly (1724) is illustrated in the open position, and may be modified by user
operation of the handle (1728) shown in FIG. 17C. In this configuration, the snare control (1730)
may slide along the track, but is prevented from initiating a retraction operation of the snare loop
assembly (1724) and shuttle (1726) by a lock (1732). A limiter as described with respect to FIGS.
14A-14B and 15A-15B may alternatively be coupled to the snare control (1730) to prevent
premature retraction of the snare loop assembly. The snare loop assembly (1724) may be opened
and closed as necessary to ensure that the target tissue is properly ligated. The handle (1728) may
further comprise a suture control (1734) for tightening a suture loop.
[0147] After the snare loop assembly (1724) is determined to be positioned properly, the suture
loop may be released (1706) from the snare loop assembly (1724). A user may pull the suture
control (1734) out from a base of a handle (1728) in order to release the suture loop from the snare
loop assembly (1724). The closed snare loop assembly (1724) may then be opened (1708), as
shown in FIG. 17B. After opening the snare loop assembly (1708), the suture loop may be
tightened (1710) around the target tissue. Then, the shuttle (1726) may be released (1712) from the
elongate body (1720), as illustrated in FIGS. 17D and 17E. The release of the shuttle (1726) from
the shuttle recess of the tip (1722) is shown in FIG. 17D and allows retraction of the snare loop
assembly (1724) and the shuttle (1726) into the tip (1722) and the elongate body (1720).
[0148] In the illustrative variation of FIG. 17E, the shuttle (1726) may be released from the
elongate body (1720) by removing the suture control (1734) from the handle (1728) and inserting
the suture control (1734) into an opening in the handle to contact a release assembly (not shown)
provided within the handle (1728). For example, the suture control (1734) may engage with the
release assembly, which may retract a lock wire to release the shuttle (1726) from the elongate body
(1720), as described above. The engagement of the suture control (1734) with the release assembly
may, in some variations, further simultaneously release/unlock the lock (1732). The lock (1632)
may then be removed from the track to allow the snare control (1730) to be moved further
proximally along the track of the handle (1728).
50WO 2017/147519 PCT/US2017/019495
[0149] Next, FIGS. 17F and 17G illustrate retraction (1714) of the shuttle (1726) into the elongate
body (1720) such as into a lumen (1736) of the tip (1722) and a corresponding lumen in the
elongate body (1720). The snare loop assembly (1724) and the shuttle may be retracted (1714) into
the tip (1722) and the elongate body (1720) by sliding or otherwise moving the snare control (1730)
proximally along an end portion (second portion) of the track previously covered by the lock
(1732). FIG. 17G shows the snare control (1730) at the end portion (e.g., a proximal end) of the
track to fully retract the shuttle (1726) and snare loop assembly (1724) into the elongate body
(1720).
[0150] Finally, the closure device may be withdrawn from the body (1716). As illustrated in
FIGS. 17A-17G, the snare loop assembly (1724) and the shuttle (1726) may not be retracted until
the shuttle (1726) is released from the tip (1722). In this manner, premature retraction may be
prevented, thereby improving operability and safety of the closure device.
III. Systems
[0151] Described here are systems for closing tissue, for example, a left atrial appendage. In
general, the systems may comprise any of the closure devices described herein, together with one or
more additional components. For example, the system may comprise a guide device comprising a
lumen therethrough. The lumen may be sized and configured to receive an elongate body of a
closure device described here. In some embodiments, the system may comprise a first guide wire
having a size and length adapted for accessing the left atrial appendage through the vasculature and
comprising an alignment member, a second guide wire having a size and a length adapted for
accessing the pericardial space from a subthoracic region and comprising an alignment member, and
a closure device. The alignment member may be any suitable alignment member. For example, the
alignment member may comprise radiopaque or echogenic markers, members configured to produce
an audible response, one or more interconnecting members, one or more vacuum members, or
magnets. The systems may further comprise instructions for use.
[0152] Although the foregoing implementations has, for the purposes of clarity and
understanding, been described in some detail by of illustration and example, it will be apparent that
51WO 2017/147519 PCT/US2017/019495
certain changes and modifications may be practiced, and are intended to fall within the scope of the
appended claims. Additionally, it should be understood that the components and characteristics of
the devices described herein may be used in any combination. The description of certain elements
or characteristics with respect to a specific figure are not intended to be limiting or nor should they
be interpreted to suggest that the element cannot be used in combination with any of the other
described elements.
52261281/2
Claims (38)
1. A device for closing a target tissue comprising: an elongate body comprising a lumen therethrough; a snare loop assembly comprising a snare loop and a suture loop releasably coupled to the snare loop, the snare loop assembly extending at least partially from the elongate body, wherein the snare loop comprises a moveable proximal end and a distal end releasably coupled to the elongate body; and a handle configured to retract the distal end of the snare loop into a lumen of the elongate body after the distal end is released.
2. The device of claim 1, wherein the device further comprises a shuttle coupled to the distal end of the snare loop, and wherein the shuttle releasably couples the distal end of the snare loop to the elongate body.
3. The device of claim 2, wherein the device comprises a first configuration in which the shuttle is fixedly coupled to the elongate body and a second configuration in which the shuttle is positioned within the lumen.
4. The device of claim 2, wherein the shuttle has a maximum dimension that is less than a diameter of the lumen.
5. The device of claim 1, wherein the elongate body comprises an approximately L-shaped recess in a side wall of the elongate body. 53 02589033\46-01261281/2
6. The device of claim 5, wherein a distal portion of the snare loop is positioned in the recess when the distal end of the snare loop is coupled to the elongate body.
7. The device of claim 1, wherein a retention member releasably couples the suture loop to the snare loop, and wherein the handle is configured to retract the entire retention member into the lumen after the distal end of the snare is released.
8. The device of claim 1, wherein the handle comprises a track, a snare control coupled to the track, and a lock configured to limit movement of the snare control along the track.
9. The device of claim 8, wherein the handle further comprises a release assembly configured to release the distal end of the snare from the elongate body and allow movement of the snare control along the track.
10. The device of claim 8, wherein the track comprises a first portion and a second portion, and the lock limits movement of the snare control along the second portion of the track.
11. A device for closing a target tissue comprising: an elongate body comprising a lumen therethrough; a snare loop assembly comprising a snare and a suture loop releasably coupled to the snare, the snare loop assembly extending at least partially from the elongate body; and a shuttle connected to a distal portion of the snare and releasably coupled to the elongate body, wherein the shuttle comprises a configuration to fit into the lumen. 54 02589033\46-01261281/2
12. The device of claim 11, wherein the elongate body comprises an approximately L-shaped recess in a side wall of the elongate body.
13. The device of claim 12, wherein the distal portion of the snare is positioned in the recess when the shuttle is coupled to the elongate body.
14. The device of claim 11 further comprising a lock wire configured to releasably couple the shuttle to the elongate body.
15. The device of claim 14, wherein the shuttle comprises a snare lumen and a proximal portion of the snare lumen comprises an offset obround.
16. The device of claim 11, wherein a distal portion of the elongate body comprises a corner chamfer.
17. The device of claim 16 further comprising a tip coupled to the distal portion of the elongate body wherein the tip comprises a tip lumen and a proximal portion of the tip comprises a tip chamfer.
18. The device of claim 17, wherein the tip chamfer is 30 degrees and offset from the tip lumen.
19. The device of claim 11, wherein the elongate body comprises a shuttle recess, and wherein the shuttle is disposed within the shuttle recess when the shuttle is coupled to the elongate body.
20. The device of claim 11 wherein a diameter of the lumen of the elongate body is equal to or less than about 1.60 mm.
21. The device of claim 11, wherein the device comprises a first configuration in which the shuttle is fixedly coupled to the elongate 55 02589033\46-01261281/2 body and a second configuration in which the shuttle is positioned within the lumen.
22. The device of claim 11, wherein the shuttle has a maximum dimension that is less than a diameter of the lumen.
23. A device for closing a target tissue comprising: an elongate body; a snare loop assembly comprising a snare and a suture loop releasably coupled to the snare, the snare loop assembly extending at least partially from the elongate body; a shuttle releasably coupled to the elongate body, wherein the shuttle is connected to a distal portion of the snare; and a handle attached to the elongate body, the handle comprising a track, a snare control coupled to the track, and a release assembly housed within the handle, wherein the snare control comprises a limiter configured to limit movement of the snare control along a proximal portion of the track, and wherein the release assembly is configured to release the shuttle from the elongate body and disengage the limiter to allow movement of the snare control along the proximal portion the track.
24. The device of claim 23 further comprising a suture control for tightening the suture loop.
25. The device of claim 24, wherein the suture control comprises a proximal portion configured to engage the release assembly through an opening in the handle and disengage the limiter from the release assembly. 56 02589033\46-01261281/2
26. The device of claim 24, wherein the release assembly comprises a flexible latch configured to limit movement of the release assembly after engagement of the suture control to the release assembly.
27. The device of claim 23, wherein the limiter extends along a length of the track.
28. The device of claim 23 further comprising a lock wire configured to releasably couple the shuttle to the elongate body.
29. A device for closing a target tissue comprising: an elongate body; a snare loop assembly comprising a snare and a suture loop releasably coupled to the snare, and the snare loop assembly extending at least partially from the elongate body; a shuttle releasably coupled to the elongate body, wherein the shuttle is connected to a distal portion of the snare; and a handle attached to the elongate body, the handle comprising a track and a snare control coupled to the track, wherein the handle further comprises a lock configured to limit movement of the snare control along the track and a release assembly configured to release the shuttle from the elongate body and allow movement of the snare control along the track.
30. The device of claim 29 further comprising a suture control configured to tighten the suture loop.
31. The device of claim 30, wherein the suture control comprises a proximal portion configured to engage the release assembly through an opening in the handle and disengage the lock from the release assembly. 57 02589033\46-01261281/2
32. The device of claim 29, wherein the lock comprises a stopper extending along a length of the track.
33. The device of claim 32, wherein the lock further comprises a lock engagement portion comprising an opening, wherein the opening is releasably coupled to the release assembly.
34. The device of claim 33, wherein the release engagement portion extends from a bottom surface of the stopper.
35. The device of claim 33, wherein the release assembly comprises a release engagement portion, and wherein the lock engagement portion is releasably coupled to the release engagement portion.
36. The device of claim 35, wherein the release engagement portion comprises a base and a protrusion, and wherein the protrusion is configured to fit within the opening of the lock to releasably couple the lock engagement portion and the release engagement portion.
37. The device of claim 33, wherein the lock further comprises an end plate.
38. The device of claim 29 further comprising a lock wire configured to releasably couple the shuttle to the elongate body. 58 02589033\46-01
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201662300608P | 2016-02-26 | 2016-02-26 | |
PCT/US2017/019495 WO2017147519A1 (en) | 2016-02-26 | 2017-02-24 | Devices and methods for left atrial appendage closure |
Publications (2)
Publication Number | Publication Date |
---|---|
IL261281A true IL261281A (en) | 2018-10-31 |
IL261281B IL261281B (en) | 2022-05-01 |
Family
ID=59678686
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
IL261281A IL261281B (en) | 2016-02-26 | 2018-08-21 | Devices and methods for left atrial appendage closure |
Country Status (8)
Country | Link |
---|---|
US (3) | US10292710B2 (en) |
EP (2) | EP4331509A2 (en) |
JP (2) | JP7137472B2 (en) |
CN (1) | CN108882949B (en) |
AU (2) | AU2017223996B2 (en) |
CA (1) | CA3015804A1 (en) |
IL (1) | IL261281B (en) |
WO (1) | WO2017147519A1 (en) |
Families Citing this family (17)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
BRPI0808618B8 (en) | 2007-03-30 | 2021-06-22 | Sentreheart Inc | devices and systems for closing the left atrial appendage |
ES2705473T3 (en) | 2009-04-01 | 2019-03-25 | Sentreheart Inc | Tissue ligation device and controls thereof |
EP3378416B1 (en) | 2013-03-12 | 2020-07-29 | Sentreheart, Inc. | Tissue ligation devices |
WO2014164572A1 (en) | 2013-03-13 | 2014-10-09 | Kaplan Aaron V | Devices and methods for excluding the left atrial appendage |
US10258408B2 (en) | 2013-10-31 | 2019-04-16 | Sentreheart, Inc. | Devices and methods for left atrial appendage closure |
US10130369B2 (en) | 2015-03-24 | 2018-11-20 | Sentreheart, Inc. | Tissue ligation devices and methods therefor |
EP3273866B1 (en) | 2015-03-24 | 2023-12-13 | AtriCure, Inc. | Devices for left atrial appendage closure |
US10085756B2 (en) | 2015-07-24 | 2018-10-02 | Covidien Lp | Anvil assembly and anvil assembly delivery system |
EP4331509A2 (en) | 2016-02-26 | 2024-03-06 | AtriCure, Inc. | Devices for left atrial appendage closure |
US11224435B2 (en) | 2016-09-23 | 2022-01-18 | Sentreheart Llc | Devices and Methods for left atrial appendage closure |
US11026695B2 (en) | 2016-10-27 | 2021-06-08 | Conformal Medical, Inc. | Devices and methods for excluding the left atrial appendage |
US11191547B2 (en) | 2018-01-26 | 2021-12-07 | Syntheon 2.0, LLC | Left atrial appendage clipping device and methods for clipping the LAA |
CN112135571A (en) | 2018-03-27 | 2020-12-25 | 森特里心脏股份有限公司 | Device and method for left atrial appendage closure |
WO2019212864A1 (en) * | 2018-05-03 | 2019-11-07 | New World Medical, Inc. | Apparatus and method for cataract extraction |
US11723637B2 (en) * | 2018-10-19 | 2023-08-15 | New Wave Endo-Surgical Corp. | Method and apparatus for intra-abdominal assembly, disassembly and retrieval of laparoscopic instruments |
US10925615B2 (en) | 2019-05-03 | 2021-02-23 | Syntheon 2.0, LLC | Recapturable left atrial appendage clipping device and methods for recapturing a left atrial appendage clip |
SE1930292A1 (en) * | 2019-09-11 | 2020-12-15 | Scandinavian Health Trade Ab | Device and method for applying a thread snare around a skin flap |
Family Cites Families (361)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3496932A (en) | 1967-12-22 | 1970-02-24 | Gen Motors Corp | Method and apparatus for substernal cardiac massage |
US3677597A (en) | 1971-03-30 | 1972-07-18 | Harold A Stipek | Loop-supporting device |
US3802074A (en) | 1971-05-21 | 1974-04-09 | C Hoppe | Surgical suture extractor |
DE2132808C3 (en) * | 1971-07-01 | 1981-10-29 | Deyhle, Peter, Dr.med., 8520 Erlangen | Device for the diathermic removal of growths |
US3841685A (en) | 1973-02-01 | 1974-10-15 | A Kolodziej | Line handling device |
US3828790A (en) * | 1973-02-28 | 1974-08-13 | American Cystoscope Makers Inc | Surgical snare |
US4018229A (en) | 1974-09-13 | 1977-04-19 | Olympus Optical Co., Ltd. | Apparatus for ligation of affected part in coeloma |
US4030509A (en) | 1975-09-30 | 1977-06-21 | Mieczyslaw Mirowski | Implantable electrodes for accomplishing ventricular defibrillation and pacing and method of electrode implantation and utilization |
US3999555A (en) | 1975-10-28 | 1976-12-28 | Medtronic, Inc. | Atrial pinch on lead and insertion tool |
GB1506142A (en) | 1975-11-17 | 1978-04-05 | Akiyama T | Cutting apparatus for surgical thread |
US4069825A (en) | 1976-01-28 | 1978-01-24 | Taichiro Akiyama | Surgical thread and cutting apparatus for the same |
US4319562A (en) | 1977-12-28 | 1982-03-16 | The University Of Virginia Alumni Patents Foundation | Method and apparatus for permanent epicardial pacing or drainage of pericardial fluid and pericardial biopsy |
US4181123A (en) | 1977-12-28 | 1980-01-01 | The University Of Virginia Alumni Patents Foundation | Apparatus for cardiac surgery and treatment of cardiovascular disease |
US4249536A (en) | 1979-05-14 | 1981-02-10 | Vega Roger E | Urological catheter |
US4257278A (en) | 1979-08-24 | 1981-03-24 | General Electric Company | Quantitative volume blood flow measurement by an ultrasound imaging system featuring a Doppler modality |
US4765341A (en) | 1981-06-22 | 1988-08-23 | Mieczyslaw Mirowski | Cardiac electrode with attachment fin |
US4428375A (en) | 1982-02-16 | 1984-01-31 | Ellman Barry R | Surgical bag for splenorrhaphy |
GB2150889B (en) | 1983-12-08 | 1987-06-03 | Thomas Ball Mcglinn | Rescue device |
CN85201912U (en) * | 1985-05-22 | 1986-06-04 | 中国铅笔一厂 | Multi-purpose step-feeding handwork knife |
US4662377A (en) | 1985-11-07 | 1987-05-05 | Mieczyslaw Mirowski | Cardioverting method and apparatus utilizing catheter and patch electrodes |
US4817608A (en) | 1987-05-29 | 1989-04-04 | Mieczyslaw Mirowski | Cardioverting transvenous catheter/patch electrode system and method for its use |
US5033477A (en) | 1987-11-13 | 1991-07-23 | Thomas J. Fogarty | Method and apparatus for providing intrapericardial access and inserting intrapericardial electrodes |
US4901405A (en) | 1988-08-25 | 1990-02-20 | Grover Alfred H | Self-aligning magnetic necklace clasp |
US4944753A (en) | 1988-09-26 | 1990-07-31 | Burgess Frank M | Method for producing retro-sternal space |
US5678547A (en) | 1988-12-22 | 1997-10-21 | Biofield Corp. | Method and apparatus for screening or sensing bodily conditions using DC biopotentials |
US4991578A (en) | 1989-04-04 | 1991-02-12 | Siemens-Pacesetter, Inc. | Method and system for implanting self-anchoring epicardial defibrillation electrodes |
US5433730A (en) | 1989-05-03 | 1995-07-18 | Intermedics, Inc. | Conductive pouch electrode for defibrillation |
US4991603A (en) | 1989-10-30 | 1991-02-12 | Siemens-Pacesetter, Inc. | Transvenously placed defibrillation leads via an inferior vena cava access site and method of use |
US4998975A (en) | 1989-10-30 | 1991-03-12 | Siemens-Pacesetter, Inc. | Travenously placed defibrillation leads |
US5226908A (en) | 1989-12-05 | 1993-07-13 | Inbae Yoon | Multi-functional instruments and stretchable ligating and occluding devices |
US5163946A (en) | 1990-04-25 | 1992-11-17 | Mitek Surgical Products, Inc. | Suture rundown tool and cutter system |
US5176691A (en) | 1990-09-11 | 1993-01-05 | Pierce Instruments, Inc. | Knot pusher |
US5108406A (en) | 1990-12-14 | 1992-04-28 | L.P. Wagi | Instrument to retrieve intraluminal objects |
US5181123A (en) | 1991-03-29 | 1993-01-19 | Thomson Consumer Electronics, Inc. | Cathode-ray tube having a shrinkfit implosion protection band with tension limiting means |
US5181919A (en) | 1991-04-23 | 1993-01-26 | Arieh Bergman | Suture ligating device for use with an endoscope |
JPH05267604A (en) | 1991-05-08 | 1993-10-15 | Seiko Instr Inc | Manufacture of semiconductor device |
CN2093730U (en) * | 1991-05-20 | 1992-01-22 | 谭刚 | Hand cut-off knife |
US5676636A (en) | 1994-07-22 | 1997-10-14 | Origin Medsystems, Inc. | Method for creating a mediastinal working space |
US5243977A (en) | 1991-06-26 | 1993-09-14 | Trabucco Hector O | Pacemaker |
US5766151A (en) | 1991-07-16 | 1998-06-16 | Heartport, Inc. | Endovascular system for arresting the heart |
US5452733A (en) | 1993-02-22 | 1995-09-26 | Stanford Surgical Technologies, Inc. | Methods for performing thoracoscopic coronary artery bypass |
AU657364B2 (en) | 1991-10-18 | 1995-03-09 | United States Surgical Corporation | Self contained gas powered surgical apparatus |
US5269326A (en) | 1991-10-24 | 1993-12-14 | Georgetown University | Method for transvenously accessing the pericardial space via the right auricle for medical procedures |
US5281238A (en) | 1991-11-22 | 1994-01-25 | Chin Albert K | Endoscopic ligation instrument |
US5163942A (en) | 1991-12-09 | 1992-11-17 | Everest Medical Corporation | Surgical instrument with grasping loop for laparoscopic procedures |
US5226535A (en) | 1992-02-14 | 1993-07-13 | Ethicon, Inc. | Package for endoscopic suture loop and cannula |
US5318578A (en) | 1992-03-17 | 1994-06-07 | Harrith M. Hasson | Apparatus for delivering a suture into a body cavity and method of using the apparatus |
US5336231A (en) | 1992-05-01 | 1994-08-09 | Adair Edwin Lloyd | Parallel channel fixation, repair and ligation suture device |
US5540711A (en) | 1992-06-02 | 1996-07-30 | General Surgical Innovations, Inc. | Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization |
US5336252A (en) | 1992-06-22 | 1994-08-09 | Cohen Donald M | System and method for implanting cardiac electrical leads |
CA2098896C (en) | 1992-06-30 | 2005-03-29 | H. Jonathan Tovey | Specimen retrieval pouch and method for use |
US5242459A (en) | 1992-07-10 | 1993-09-07 | Laparomed Corporation | Device and method for applying a ligating loop |
US5443481A (en) | 1992-07-27 | 1995-08-22 | Lee; Benjamin I. | Methods and device for percutaneous sealing of arterial puncture sites |
US5676651A (en) | 1992-08-06 | 1997-10-14 | Electric Boat Corporation | Surgically implantable pump arrangement and method for pumping body fluids |
US5279539A (en) | 1992-08-17 | 1994-01-18 | Ethicon, Inc. | Drawstring surgical pouch and method of use for preventing ovarian adhesions |
US5334199A (en) | 1992-08-17 | 1994-08-02 | Inbae Yoon | Ligating instrument and methods of ligating tissue in endoscopic operative procedures |
AU674510B2 (en) | 1992-09-23 | 1997-01-02 | Target Therapeutics, Inc. | Medical retrieval device |
US5312423A (en) | 1992-10-01 | 1994-05-17 | Advanced Surgical Intervention, Inc. | Apparatus and method for laparaoscopic ligation |
US5300078A (en) | 1992-10-09 | 1994-04-05 | Laparomed Corporation | Device and method for applying large-diameter ligating loop |
DE69315808T2 (en) | 1992-11-17 | 1998-04-09 | Smith & Nephew Inc | Device for fastening sutures |
DE4240533C1 (en) | 1992-11-27 | 1994-04-07 | Ethicon Gmbh | Endoscopic loop with application instrument - has knife on distal end of actuating member acting against free portion of surgical thread |
US6283127B1 (en) | 1992-12-03 | 2001-09-04 | Wesley D. Sterman | Devices and methods for intracardiac procedures |
US5398944A (en) | 1992-12-07 | 1995-03-21 | A. W. Chesterton Co. | Sealing system for reciprocating rod |
USRE36269E (en) | 1993-01-21 | 1999-08-17 | Minnesota Mining And Manufacturing Company | Saw blade retention system |
US5340129A (en) | 1993-01-21 | 1994-08-23 | Minnesota Mining And Manufacturing Company | Saw blade retention system |
US5336229A (en) | 1993-02-09 | 1994-08-09 | Laparomed Corporation | Dual ligating and dividing apparatus |
US6161543A (en) | 1993-02-22 | 2000-12-19 | Epicor, Inc. | Methods of epicardial ablation for creating a lesion around the pulmonary veins |
US6494211B1 (en) | 1993-02-22 | 2002-12-17 | Hearport, Inc. | Device and methods for port-access multivessel coronary artery bypass surgery |
US5797960A (en) | 1993-02-22 | 1998-08-25 | Stevens; John H. | Method and apparatus for thoracoscopic intracardiac procedures |
US6010531A (en) | 1993-02-22 | 2000-01-04 | Heartport, Inc. | Less-invasive devices and methods for cardiac valve surgery |
US5799661A (en) | 1993-02-22 | 1998-09-01 | Heartport, Inc. | Devices and methods for port-access multivessel coronary artery bypass surgery |
US5624453A (en) | 1993-02-23 | 1997-04-29 | Wilson-Cook Medical, Inc. | Endoscopic ligating instrument |
US6346074B1 (en) | 1993-02-22 | 2002-02-12 | Heartport, Inc. | Devices for less invasive intracardiac interventions |
US5682906A (en) | 1993-02-22 | 1997-11-04 | Heartport, Inc. | Methods of performing intracardiac procedures on an arrested heart |
WO1994020029A1 (en) | 1993-03-11 | 1994-09-15 | Wilson Greatbatch Ltd. | Laparoscopic surgical grasper |
US5403331A (en) | 1993-03-12 | 1995-04-04 | United States Surgical Corporation | Looped suture ligating device containing a heat-shrinkable element |
US5306234A (en) | 1993-03-23 | 1994-04-26 | Johnson W Dudley | Method for closing an atrial appendage |
US5540698A (en) | 1993-04-21 | 1996-07-30 | Amei Technologies Inc. | System and method for securing a medical cable |
US5449361A (en) | 1993-04-21 | 1995-09-12 | Amei Technologies Inc. | Orthopedic cable tensioner |
US6258021B1 (en) | 1993-06-17 | 2001-07-10 | Peter J. Wilk | Intrapericardial assist method |
US6155968A (en) | 1998-07-23 | 2000-12-05 | Wilk; Peter J. | Method and device for improving cardiac function |
US5423830A (en) | 1993-07-07 | 1995-06-13 | Schneebaum; Cary W. | Polyp retrieval method and associated instrument assembly |
US5683364A (en) | 1993-07-30 | 1997-11-04 | Zadini; Filiberto | Percutaneous cardiac pump for cardiopulmonary resuscitation |
US5385156A (en) | 1993-08-27 | 1995-01-31 | Rose Health Care Systems | Diagnostic and treatment method for cardiac rupture and apparatus for performing the same |
US5609597A (en) | 1993-12-09 | 1997-03-11 | Lehrer; Theodor | Apparatus and method of extracorporeally applying and locking laparoscopic suture and loop ligatures |
US5536273A (en) | 1993-12-09 | 1996-07-16 | Lehrer; Theodor | Apparatus and method of extracorporeally applying and locking laparoscopic suture and loop ligatures |
AU1675995A (en) | 1994-01-10 | 1995-08-01 | Cardassist Incorporated | Ventricular assist device |
US5423821A (en) | 1994-01-18 | 1995-06-13 | Pasque; Michael K. | Sternal closure device |
JPH07296645A (en) | 1994-04-21 | 1995-11-10 | Sumitomo Electric Ind Ltd | Shield wire facilitating terminal working and manufacture thereof |
US5545178A (en) | 1994-04-29 | 1996-08-13 | Kensey Nash Corporation | System for closing a percutaneous puncture formed by a trocar to prevent tissue at the puncture from herniating |
WO1995032669A1 (en) | 1994-06-01 | 1995-12-07 | Perclose, Inc. | Apparatus and method for advancing surgical knots |
US5681278A (en) | 1994-06-23 | 1997-10-28 | Cormedics Corp. | Coronary vasculature treatment method |
US5498228A (en) | 1994-08-08 | 1996-03-12 | John W. Royalty | Electromagnetic bi-ventricular assist device |
US5601576A (en) | 1994-08-10 | 1997-02-11 | Heartport Inc. | Surgical knot pusher and method of use |
CA2156027C (en) | 1994-10-04 | 2006-07-18 | Keith Ratcliff | Surgical retractor |
US5494240A (en) | 1994-10-07 | 1996-02-27 | The United States Of America As Represented By The Secretary Of The Navy | Vehicle recovery device for use by helicopter |
US7175619B2 (en) | 1994-10-07 | 2007-02-13 | Boston Scientific Scimed, Inc. | Loop structures for positioning a diagnostic or therapeutic element on the epicardium or other organ surface |
US6464700B1 (en) | 1994-10-07 | 2002-10-15 | Scimed Life Systems, Inc. | Loop structures for positioning a diagnostic or therapeutic element on the epicardium or other organ surface |
US6152920A (en) | 1997-10-10 | 2000-11-28 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body |
DE4438944C2 (en) | 1994-10-31 | 2003-10-09 | Wolf Gmbh Richard | endoscope |
US5624430A (en) | 1994-11-28 | 1997-04-29 | Eton; Darwin | Magnetic device to assist transcorporeal guidewire placement |
US5499991A (en) * | 1994-12-19 | 1996-03-19 | Linvatec Corporation | Endoscopic needle with suture retriever |
US5707336A (en) | 1995-01-09 | 1998-01-13 | Cardassist Incorporated | Ventricular assist device |
CA2158976C (en) | 1995-02-07 | 2005-05-24 | Thomas E. Watson, Jr. | Telescoping serial elastic band ligator |
US5888247A (en) | 1995-04-10 | 1999-03-30 | Cardiothoracic Systems, Inc | Method for coronary artery bypass |
US5571161A (en) | 1995-04-12 | 1996-11-05 | Starksen; Niel F. | Apparatus and method for implanting electrical leads in the heart |
US5827216A (en) | 1995-06-07 | 1998-10-27 | Cormedics Corp. | Method and apparatus for accessing the pericardial space |
US5797870A (en) | 1995-06-07 | 1998-08-25 | Indiana University Foundation | Pericardial delivery of therapeutic and diagnostic agents |
US5840059A (en) | 1995-06-07 | 1998-11-24 | Cardiogenesis Corporation | Therapeutic and diagnostic agent delivery |
US6224584B1 (en) | 1997-01-14 | 2001-05-01 | Eclipse Surgical Technologies, Inc. | Therapeutic and diagnostic agent delivery |
US6132438A (en) | 1995-06-07 | 2000-10-17 | Ep Technologies, Inc. | Devices for installing stasis reducing means in body tissue |
US5902311A (en) | 1995-06-15 | 1999-05-11 | Perclose, Inc. | Low profile intraluminal suturing device and method |
US5900433A (en) | 1995-06-23 | 1999-05-04 | Cormedics Corp. | Vascular treatment method and apparatus |
US5814052A (en) | 1995-06-29 | 1998-09-29 | Nakao; Naomi L. | Surgical cauterization snare with ligating suture |
US5797946A (en) | 1995-07-13 | 1998-08-25 | Origin Medsystems, Inc. | Method for arterial harvest and anastomosis for coronary bypass grafting |
US5693059A (en) | 1995-09-15 | 1997-12-02 | Yoon; Inbae | Ligating instrument with multiple loop ligature supply and methods therefor |
US5704943A (en) | 1995-09-25 | 1998-01-06 | Yoon; Inbae | Ligating instrument with multiple loop ligature supply and methods therefor |
JP3293118B2 (en) | 1995-10-18 | 2002-06-17 | ニプロ株式会社 | Catheter assembly for endocardial suture surgery |
US5716392A (en) | 1996-01-05 | 1998-02-10 | Medtronic, Inc. | Minimally invasive medical electrical lead |
US5792151A (en) | 1996-01-24 | 1998-08-11 | The Ohio State University | Method and apparatus for ligating a blood vessel, tissue or other bodily duct |
US5752526A (en) | 1996-02-19 | 1998-05-19 | The Cleveland Clinic Foundation | Minimally invasive cardiac surgery procedure |
US5727569A (en) | 1996-02-20 | 1998-03-17 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery |
US5735877A (en) | 1996-02-28 | 1998-04-07 | Pagedas; Anthony C. | Self locking suture lock |
US5871496A (en) | 1996-03-20 | 1999-02-16 | Cardiothoracic Systems, Inc. | Surgical instrument for facilitating the detachment of an artery and the like |
JP4136020B2 (en) | 1996-04-17 | 2008-08-20 | オリンパス株式会社 | Medical ligature |
US5683445A (en) | 1996-04-29 | 1997-11-04 | Swoyer; John M. | Medical electrical lead |
US5766216A (en) | 1996-05-30 | 1998-06-16 | Gangal; Hanamraddi T. | Band applicator for appendicular and meso-appendicular stumps |
US6059750A (en) | 1996-08-01 | 2000-05-09 | Thomas J. Fogarty | Minimally invasive direct cardiac massage device and method |
US5904147A (en) | 1996-08-16 | 1999-05-18 | University Of Massachusetts | Intravascular catheter and method of controlling hemorrhage during minimally invasive surgery |
US5766217A (en) | 1996-09-23 | 1998-06-16 | Christy; William J. | Surgical loop delivery device and method |
US6152936A (en) | 1996-09-23 | 2000-11-28 | Esd Medical, Llc | Surgical loop delivery device |
US6311692B1 (en) | 1996-10-22 | 2001-11-06 | Epicor, Inc. | Apparatus and method for diagnosis and therapy of electrophysiological disease |
US6237605B1 (en) | 1996-10-22 | 2001-05-29 | Epicor, Inc. | Methods of epicardial ablation |
US6206004B1 (en) | 1996-12-06 | 2001-03-27 | Comedicus Incorporated | Treatment method via the pericardial space |
US5910129A (en) | 1996-12-19 | 1999-06-08 | Ep Technologies, Inc. | Catheter distal assembly with pull wires |
US6048329A (en) | 1996-12-19 | 2000-04-11 | Ep Technologies, Inc. | Catheter distal assembly with pull wires |
US6332880B1 (en) | 1996-12-19 | 2001-12-25 | Ep Technologies, Inc. | Loop structures for supporting multiple electrode elements |
US5961440A (en) | 1997-01-02 | 1999-10-05 | Myocor, Inc. | Heart wall tension reduction apparatus and method |
US5882299A (en) | 1997-01-31 | 1999-03-16 | Minnesota Scientific, Inc. | Device and procedure for minimally invasive coronary anastomosis |
US5699748A (en) | 1997-02-06 | 1997-12-23 | Linskey, Jr.; Edward | Line handling device for positioning and handling of mooring lines |
US6045570A (en) | 1997-02-11 | 2000-04-04 | Biointerventional Corporation | Biological sealant mixture and system for use in percutaneous occlusion of puncture sites and tracts in the human body and method |
US5779727A (en) | 1997-02-18 | 1998-07-14 | Orejola; Wilmo C. | Hydraulically operated surgical scissors |
US5893869A (en) | 1997-02-19 | 1999-04-13 | University Of Iowa Research Foundation | Retrievable inferior vena cava filter system and method for use thereof |
US6120431A (en) | 1997-03-14 | 2000-09-19 | Allegheny-Singer Research Institute | Method for assisting stystolic and diastolic cardiac function |
US5897487A (en) * | 1997-04-15 | 1999-04-27 | Asahi Kogaku Kogyo Kabushiki Kaisha | Front end hood for endoscope |
US6319201B1 (en) | 1997-10-15 | 2001-11-20 | Peter J. Wilk | Imaging device and associated method |
US6200303B1 (en) | 1997-04-30 | 2001-03-13 | Beth Israel Deaconess Medical Center, Inc. | Method and kit for transvenously accessing the pericardial space via the right atrium |
US5968010A (en) | 1997-04-30 | 1999-10-19 | Beth Israel Deaconess Medical Center, Inc. | Method for transvenously accessing the pericardial space via the right atrium |
US5957936A (en) | 1997-05-01 | 1999-09-28 | Inbae Yoon | Instrument assemblies for performing anatomical tissue ligation |
US5908429A (en) | 1997-05-01 | 1999-06-01 | Yoon; Inbae | Methods of anatomical tissue ligation |
US5895298A (en) | 1997-05-29 | 1999-04-20 | Biofield Corp. | DC biopotential electrode connector and connector condition sensor |
US5851185A (en) | 1997-07-02 | 1998-12-22 | Cabot Technology Corporation | Apparatus for alignment of tubular organs |
US5897586A (en) | 1997-08-15 | 1999-04-27 | Regents Of The University Of Minnesota | Implantable defibrillator lead |
US5972013A (en) | 1997-09-19 | 1999-10-26 | Comedicus Incorporated | Direct pericardial access device with deflecting mechanism and method |
US6592552B1 (en) | 1997-09-19 | 2003-07-15 | Cecil C. Schmidt | Direct pericardial access device and method |
US5991668A (en) | 1997-09-25 | 1999-11-23 | Medtronic, Inc. | Medical electrical lead |
US6006122A (en) | 1997-09-25 | 1999-12-21 | Medtronic, Inc. | Medical electrical lead |
US5871531A (en) | 1997-09-25 | 1999-02-16 | Medtronic, Inc. | Medical electrical lead having tapered spiral fixation |
US6610055B1 (en) | 1997-10-10 | 2003-08-26 | Scimed Life Systems, Inc. | Surgical method for positioning a diagnostic or therapeutic element on the epicardium or other organ surface |
US6071281A (en) | 1998-05-05 | 2000-06-06 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body and remote power control unit for use with same |
US6015382A (en) | 1997-10-16 | 2000-01-18 | General Surgical Innovations, Inc. | Inflatable manipulator for organ positioning during surgery and method of use |
US5908435A (en) | 1997-10-23 | 1999-06-01 | Samuels; Shaun L. W. | Expandable lumen device and method of use |
US6081738A (en) | 1998-01-15 | 2000-06-27 | Lumend, Inc. | Method and apparatus for the guided bypass of coronary occlusions |
AU1927399A (en) | 1998-01-16 | 1999-08-02 | Lumend, Inc. | Catheter apparatus for treating arterial occlusions |
US6090042A (en) | 1998-01-23 | 2000-07-18 | Rullo; Janice Lee | Surgical support apparatus with adjustable rake and adjustable cable lifting disk |
US5964699A (en) | 1998-01-23 | 1999-10-12 | Rultract, Inc. | Surgical support apparatus with a Z-shape rake plate |
US5984866A (en) | 1998-01-23 | 1999-11-16 | Rultract, Inc. | Surgical support apparatus with splined coupling, cross bar support and head-to-toe extension for surgical retractor apparatus |
US6083153A (en) | 1998-01-23 | 2000-07-04 | Rultract, Inc. | Xiphoid retraction system and method of performing reoperative midsternotomy |
US6148230A (en) | 1998-01-30 | 2000-11-14 | Uab Research Foundation | Method for the monitoring and treatment of spontaneous cardiac arrhythmias |
JP4157183B2 (en) * | 1998-02-17 | 2008-09-24 | オリンパス株式会社 | Endoscopic treatment tool |
US6296630B1 (en) | 1998-04-08 | 2001-10-02 | Biocardia, Inc. | Device and method to slow or stop the heart temporarily |
US6095968A (en) | 1998-04-10 | 2000-08-01 | Cardio Technologies, Inc. | Reinforcement device |
US6074418A (en) | 1998-04-20 | 2000-06-13 | St. Jude Medical, Inc. | Driver tool for heart valve prosthesis fasteners |
US6199556B1 (en) | 1998-05-01 | 2001-03-13 | Cardiothoracic Systems, Inc. | Xyphoid access for cardiac surgical procedures |
US6067942A (en) | 1998-05-21 | 2000-05-30 | Fernandez; John Bernard | Fish lasso |
US6231518B1 (en) | 1998-05-26 | 2001-05-15 | Comedicus Incorporated | Intrapericardial electrophysiological procedures |
US6149595A (en) | 1998-07-02 | 2000-11-21 | Seitz; Walter S. | Noninvasive apparatus and method for the determination of cardiac valve function |
US7335220B2 (en) | 2004-11-05 | 2008-02-26 | Access Closure, Inc. | Apparatus and methods for sealing a vascular puncture |
EP1112043B1 (en) | 1998-09-10 | 2006-04-05 | Percardia, Inc. | Tmr shunt |
US7128073B1 (en) | 1998-11-06 | 2006-10-31 | Ev3 Endovascular, Inc. | Method and device for left atrial appendage occlusion |
US7713282B2 (en) | 1998-11-06 | 2010-05-11 | Atritech, Inc. | Detachable atrial appendage occlusion balloon |
US6152144A (en) | 1998-11-06 | 2000-11-28 | Appriva Medical, Inc. | Method and device for left atrial appendage occlusion |
AT3305U1 (en) | 1998-12-16 | 2000-01-25 | Ami Gmbh | ENDOSCOPIC INSTRUMENT WITH THREAD LOOP |
US6333347B1 (en) | 1999-01-29 | 2001-12-25 | Angiotech Pharmaceuticals & Advanced Research Tech | Intrapericardial delivery of anti-microtubule agents |
US6132439A (en) * | 1999-02-17 | 2000-10-17 | X-Site, L.L.C. | Knot pusher |
US6280415B1 (en) | 1999-03-10 | 2001-08-28 | W. Dudley Johnson | Tissue traction device |
US6077277A (en) | 1999-04-05 | 2000-06-20 | Starion Instruments, Inc. | Suture welding device |
US6752813B2 (en) | 1999-04-09 | 2004-06-22 | Evalve, Inc. | Methods and devices for capturing and fixing leaflets in valve repair |
US7666204B2 (en) | 1999-04-09 | 2010-02-23 | Evalve, Inc. | Multi-catheter steerable guiding system and methods of use |
ATE492219T1 (en) | 1999-04-09 | 2011-01-15 | Evalve Inc | DEVICE FOR HEART VALVE OPERATION |
US6045571A (en) | 1999-04-14 | 2000-04-04 | Ethicon, Inc. | Multifilament surgical cord |
US6488689B1 (en) | 1999-05-20 | 2002-12-03 | Aaron V. Kaplan | Methods and apparatus for transpericardial left atrial appendage closure |
US7264587B2 (en) | 1999-08-10 | 2007-09-04 | Origin Medsystems, Inc. | Endoscopic subxiphoid surgical procedures |
US20030187460A1 (en) | 1999-08-10 | 2003-10-02 | Chin Albert K. | Methods and apparatus for endoscopic cardiac surgery |
US20040102804A1 (en) | 1999-08-10 | 2004-05-27 | Chin Albert K. | Apparatus and methods for endoscopic surgical procedures |
JP3901421B2 (en) | 1999-08-19 | 2007-04-04 | 有限会社 パックス オプティカ ジャパン | Organ anastomosis device |
US6328689B1 (en) | 2000-03-23 | 2001-12-11 | Spiration, Inc., | Lung constriction apparatus and method |
US6423051B1 (en) | 1999-09-16 | 2002-07-23 | Aaron V. Kaplan | Methods and apparatus for pericardial access |
US6231561B1 (en) | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6652555B1 (en) | 1999-10-27 | 2003-11-25 | Atritech, Inc. | Barrier device for covering the ostium of left atrial appendage |
US6551303B1 (en) | 1999-10-27 | 2003-04-22 | Atritech, Inc. | Barrier device for ostium of left atrial appendage |
US6613062B1 (en) | 1999-10-29 | 2003-09-02 | Medtronic, Inc. | Method and apparatus for providing intra-pericardial access |
US7758521B2 (en) | 1999-10-29 | 2010-07-20 | Medtronic, Inc. | Methods and systems for accessing the pericardial space |
US6293906B1 (en) | 2000-01-14 | 2001-09-25 | Acorn Cardiovascular, Inc. | Delivery of cardiac constraint jacket |
US6296659B1 (en) | 2000-02-29 | 2001-10-02 | Opus Medical, Inc. | Single-tailed suturing method and apparatus |
US6692491B1 (en) | 2000-03-24 | 2004-02-17 | Scimed Life Systems, Inc. | Surgical methods and apparatus for positioning a diagnostic or therapeutic element around one or more pulmonary veins or other body structures |
US7056294B2 (en) | 2000-04-13 | 2006-06-06 | Ev3 Sunnyvale, Inc | Method and apparatus for accessing the left atrial appendage |
US7144414B2 (en) | 2000-06-27 | 2006-12-05 | Smith & Nephew, Inc. | Surgical procedures and instruments |
CA2419811A1 (en) | 2000-08-18 | 2002-02-28 | Atritech, Inc. | Expandable implant devices for filtering blood flow from atrial appendages |
US6733509B2 (en) | 2000-08-25 | 2004-05-11 | Sutura, Inc. | Suture cutter |
EP1313401A4 (en) | 2000-08-30 | 2006-09-20 | Cerebral Vascular Applic Inc | Medical instrument |
US20080091264A1 (en) | 2002-11-26 | 2008-04-17 | Ample Medical, Inc. | Devices, systems, and methods for reshaping a heart valve annulus, including the use of magnetic tools |
US6666861B1 (en) | 2000-10-05 | 2003-12-23 | James R. Grabek | Atrial appendage remodeling device and method |
US6635065B2 (en) | 2000-11-16 | 2003-10-21 | Vascular Control Systems, Inc. | Doppler directed suture ligation device and method |
US7905900B2 (en) | 2003-01-30 | 2011-03-15 | Integrated Vascular Systems, Inc. | Clip applier and methods of use |
US6786898B2 (en) | 2003-01-15 | 2004-09-07 | Medtronic, Inc. | Methods and tools for accessing an anatomic space |
US20020107531A1 (en) | 2001-02-06 | 2002-08-08 | Schreck Stefan G. | Method and system for tissue repair using dual catheters |
US7842050B2 (en) | 2001-02-26 | 2010-11-30 | Diduch David R | Suture passing devices |
US6807968B2 (en) | 2001-04-26 | 2004-10-26 | Medtronic, Inc. | Method and system for treatment of atrial tachyarrhythmias |
US7011671B2 (en) | 2001-07-18 | 2006-03-14 | Atritech, Inc. | Cardiac implant device tether system and method |
US6755338B2 (en) | 2001-08-29 | 2004-06-29 | Cerebral Vascular Applications, Inc. | Medical instrument |
US6789509B1 (en) | 2001-09-24 | 2004-09-14 | Guy Dale Motsinger | Lariat with low-friction honda arm socks |
CN1310620C (en) | 2001-10-04 | 2007-04-18 | 吉本斯集团有限责任公司 | Cycling suturing and knot-tying device |
US20060020336A1 (en) | 2001-10-23 | 2006-01-26 | Liddicoat John R | Automated annular plication for mitral valve repair |
US20050149069A1 (en) | 2001-12-04 | 2005-07-07 | Bertolero Arthur A. | Left atrial appendage devices and methods |
US7749157B2 (en) | 2001-12-04 | 2010-07-06 | Estech, Inc. (Endoscopic Technologies, Inc.) | Methods and devices for minimally invasive cardiac surgery for atrial fibrillation |
US6746457B2 (en) * | 2001-12-07 | 2004-06-08 | Abbott Laboratories | Snared suture trimmer |
US7037307B2 (en) | 2001-12-07 | 2006-05-02 | Dennis William G | Automatically deforming surgical snare |
US6978176B2 (en) | 2001-12-08 | 2005-12-20 | Lattouf Omar M | Treatment for patient with congestive heart failure |
US6656175B2 (en) | 2001-12-11 | 2003-12-02 | Medtronic, Inc. | Method and system for treatment of atrial tachyarrhythmias |
EP1469790B1 (en) | 2002-01-25 | 2016-10-19 | Atritech, Inc. | Atrial appendage blood filtration systems |
US7618425B2 (en) | 2002-01-30 | 2009-11-17 | Olympus Corporation | Endoscopic suturing system |
US8105342B2 (en) | 2002-05-08 | 2012-01-31 | Apollo Endosurgery, Inc. | Apparatus for ligating/suturing living tissues and system for resecting/suturing living tissues |
US7008418B2 (en) | 2002-05-09 | 2006-03-07 | Stereotaxis, Inc. | Magnetically assisted pulmonary vein isolation |
US7610104B2 (en) | 2002-05-10 | 2009-10-27 | Cerebral Vascular Applications, Inc. | Methods and apparatus for lead placement on a surface of the heart |
US7527634B2 (en) | 2002-05-14 | 2009-05-05 | University Of Pittsburgh | Device and method of use for functional isolation of animal or human tissues |
US20060122633A1 (en) | 2002-06-13 | 2006-06-08 | John To | Methods and devices for termination |
US8287561B2 (en) | 2002-06-28 | 2012-10-16 | Boston Scientific Scimed, Inc. | Balloon-type actuator for surgical applications |
US7041111B2 (en) | 2002-08-02 | 2006-05-09 | Boston Scientific Scimed, Inc. | Placing sutures |
US7758592B2 (en) | 2002-12-02 | 2010-07-20 | Wilson-Cook Medical Inc. | Loop tip wire guide |
US20040116943A1 (en) | 2002-12-13 | 2004-06-17 | Brandt C. Phillip | Method and apparatus for endoscopically ligating an elongate tissue structure at multiple sites |
JP4197965B2 (en) * | 2003-01-31 | 2008-12-17 | オリンパス株式会社 | High frequency snare and medical equipment |
JP4094445B2 (en) | 2003-01-31 | 2008-06-04 | オリンパス株式会社 | Endoscopic mucosal resection tool |
US6985776B2 (en) | 2003-04-25 | 2006-01-10 | Medtronic, Inc. | Method and apparatus for coronary sinus cannulation |
US7747047B2 (en) | 2003-05-07 | 2010-06-29 | Ge Medical Systems Global Technology Company, Llc | Cardiac CT system and method for planning left atrial appendage isolation |
CA2525275C (en) * | 2003-05-16 | 2012-02-07 | C.R. Bard, Inc. | Single intubation, multi-stitch endoscopic suturing system |
US7331979B2 (en) | 2003-06-04 | 2008-02-19 | Access Closure, Inc. | Apparatus and methods for sealing a vascular puncture |
US20040260273A1 (en) | 2003-06-18 | 2004-12-23 | Wan Elaine Y. | Magnetic surgical instrument system |
US7344543B2 (en) | 2003-07-01 | 2008-03-18 | Medtronic, Inc. | Method and apparatus for epicardial left atrial appendage isolation in patients with atrial fibrillation |
EP1663014B1 (en) | 2003-09-11 | 2008-08-13 | NMT Medical, Inc. | Suture sever tube |
JP2005110860A (en) | 2003-10-06 | 2005-04-28 | Olympus Corp | Ligator device for medical use |
US7556647B2 (en) | 2003-10-08 | 2009-07-07 | Arbor Surgical Technologies, Inc. | Attachment device and methods of using the same |
ES2700851T3 (en) | 2003-10-09 | 2019-02-19 | Sentreheart Inc | Apparatus for tissue binding |
US7419498B2 (en) | 2003-10-21 | 2008-09-02 | Nmt Medical, Inc. | Quick release knot attachment system |
US8162925B2 (en) | 2003-11-07 | 2012-04-24 | Carnegie Mellon University | Robot for minimally invasive interventions |
US7597705B2 (en) * | 2003-12-03 | 2009-10-06 | St. Jude Medical Puerto Rico Llc | Vascular puncture seal anchor nest |
US20050149068A1 (en) | 2003-12-17 | 2005-07-07 | Mathew Williams | Left atrial appendage exclusion device |
US7186214B2 (en) | 2004-02-12 | 2007-03-06 | Medtronic, Inc. | Instruments and methods for accessing an anatomic space |
JP4643328B2 (en) | 2004-04-07 | 2011-03-02 | オリンパス株式会社 | Medical ligature suturing device |
US8932276B1 (en) | 2004-04-21 | 2015-01-13 | Acclarent, Inc. | Shapeable guide catheters and related methods |
US20060004323A1 (en) | 2004-04-21 | 2006-01-05 | Exploramed Nc1, Inc. | Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures |
US20050256532A1 (en) | 2004-05-12 | 2005-11-17 | Asha Nayak | Cardiovascular defect patch device and method |
US7931578B2 (en) | 2004-06-18 | 2011-04-26 | Ncontact Surgical, Inc. | Methods and system for tissue cavity closure |
EP1768575B1 (en) | 2004-06-18 | 2019-01-16 | Medtronic, Inc. | Devices for occlusion of an atrial appendage |
US8663245B2 (en) | 2004-06-18 | 2014-03-04 | Medtronic, Inc. | Device for occlusion of a left atrial appendage |
US20090105753A1 (en) | 2004-08-26 | 2009-04-23 | Prodesco, Inc. | Sutures and methods of making the same |
US8070693B2 (en) | 2004-09-30 | 2011-12-06 | Cook Medical Technologies Llc | Articulating steerable wire guide |
WO2006042047A1 (en) | 2004-10-07 | 2006-04-20 | Flea Street Translational, Llc | Methods, systems and devices for establishing communication between hollow organs and tissue lumens |
US7226440B2 (en) | 2005-01-31 | 2007-06-05 | G & L Consulting, Llc | Method and device for accessing a pericardial space |
JP4823533B2 (en) | 2005-02-04 | 2011-11-24 | オリンパス株式会社 | Medical suture ligation tool and medical suture ligation apparatus |
US7927270B2 (en) | 2005-02-24 | 2011-04-19 | Ethicon Endo-Surgery, Inc. | External mechanical pressure sensor for gastric band pressure measurements |
US20060200169A1 (en) | 2005-03-07 | 2006-09-07 | Kevin Sniffin | Specimen retrieval apparatus and method of use |
WO2006096805A1 (en) | 2005-03-08 | 2006-09-14 | Teleflex Medical Incorporated | Surgical suture cutter |
WO2006110734A2 (en) | 2005-04-07 | 2006-10-19 | Sentreheart, Inc. | Apparatus and method for the ligation of tissue |
JP5225072B2 (en) | 2005-04-22 | 2013-07-03 | レックス メディカル リミテッド パートナーシップ | Left atrial appendage obturator |
US20060247672A1 (en) | 2005-04-27 | 2006-11-02 | Vidlund Robert M | Devices and methods for pericardial access |
EP1909655A2 (en) | 2005-06-20 | 2008-04-16 | Sutura, Inc. | Method and apparatus for applying a knot to a suture |
US8945151B2 (en) | 2005-07-13 | 2015-02-03 | Atricure, Inc. | Surgical clip applicator and apparatus including the same |
US20090012545A1 (en) | 2005-07-14 | 2009-01-08 | Idx Medical, Ltd. | Apparatus and Methods for Occluding a Hallow Anatomical Structure |
CN102225023B (en) | 2005-07-21 | 2014-04-02 | 泰科医疗集团有限合伙公司 | Systems and methods for treating a hollow anatomical structure |
US8157818B2 (en) | 2005-08-01 | 2012-04-17 | Ension, Inc. | Integrated medical apparatus for non-traumatic grasping, manipulating and closure of tissue |
US20070038229A1 (en) | 2005-08-12 | 2007-02-15 | Towertech Research Group | Flexible endoscopic knot tying apparatus |
US20070060951A1 (en) | 2005-09-15 | 2007-03-15 | Shannon Francis L | Atrial tissue fixation device |
JP4955328B2 (en) | 2005-09-29 | 2012-06-20 | テルモ株式会社 | In vivo tissue closure device |
US20070083232A1 (en) | 2005-10-07 | 2007-04-12 | Innovasive, Inc. | Vascular closure device |
WO2007046860A2 (en) | 2005-10-12 | 2007-04-26 | Ncontact Surgical, Inc. | Diaphragm entry for posterior surgical access |
US9808280B2 (en) | 2005-10-12 | 2017-11-07 | Atricure, Inc. | Diaphragm entry for posterior surgical access |
US20070088369A1 (en) | 2005-10-14 | 2007-04-19 | Shaw William J | Snare with loop made of heat shrinkable shape memory material and method of use thereof |
US9486225B2 (en) | 2005-12-22 | 2016-11-08 | Robert E. Michler | Exclusion of the left atrial appendage |
WO2007074647A1 (en) | 2005-12-26 | 2007-07-05 | Nitto Kohki Co., Ltd. | Portable drilling machine |
US8394111B2 (en) | 2006-01-13 | 2013-03-12 | Olympus Medical Systems Corp. | Endoscopic treatment instrument and retaining device |
US8740787B2 (en) | 2006-01-27 | 2014-06-03 | Albert N. Santilli | Retraction of the left atrial appendage |
WO2007131110A2 (en) | 2006-05-03 | 2007-11-15 | Raptor Ridge, Llc | Systems and methods of tissue closure |
US20080009843A1 (en) | 2006-06-14 | 2008-01-10 | De La Torre Ralph | Surgical ablation system with chest wall platform |
US20080033241A1 (en) | 2006-08-01 | 2008-02-07 | Ruey-Feng Peh | Left atrial appendage closure |
WO2008017080A2 (en) | 2006-08-03 | 2008-02-07 | Hansen Medical, Inc. | Systems for performing minimally invasive procedures |
US20080039879A1 (en) | 2006-08-09 | 2008-02-14 | Chin Albert K | Devices and methods for atrial appendage exclusion |
US20080065156A1 (en) | 2006-09-08 | 2008-03-13 | Hauser David L | Expandable clip for tissue repair |
US20100069925A1 (en) | 2006-09-21 | 2010-03-18 | Mayo Foundation For Medical Education And Research | Devices and methods for ligating anatomical structures |
US8636767B2 (en) | 2006-10-02 | 2014-01-28 | Micell Technologies, Inc. | Surgical sutures having increased strength |
US8540734B2 (en) | 2006-11-21 | 2013-09-24 | Cayenne Medical, Inc. | Suture management and tensioning devices and methods for soft tissue reconstruction or bone-to-bone fixation |
US8480708B2 (en) | 2007-01-23 | 2013-07-09 | Cvdevices, Llc | Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion |
US8647367B2 (en) | 2007-01-23 | 2014-02-11 | Cvdevices, Llc | Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion |
US20080228265A1 (en) | 2007-03-13 | 2008-09-18 | Mitralign, Inc. | Tissue anchors, systems and methods, and devices |
BRPI0808618B8 (en) | 2007-03-30 | 2021-06-22 | Sentreheart Inc | devices and systems for closing the left atrial appendage |
US9259233B2 (en) | 2007-04-06 | 2016-02-16 | Hologic, Inc. | Method and device for distending a gynecological cavity |
US8075572B2 (en) | 2007-04-26 | 2011-12-13 | Ethicon Endo-Surgery, Inc. | Surgical suturing apparatus |
US20080294175A1 (en) | 2007-05-21 | 2008-11-27 | Epitek, Inc. | Left atrial appendage closure |
US20080294174A1 (en) | 2007-05-21 | 2008-11-27 | Epitek, Inc. | Methods and apparatus for pericardial access |
EP2148623A1 (en) | 2007-05-21 | 2010-02-03 | Epitek, Inc. | Left atrial appendage closure |
EP2182856A2 (en) | 2007-08-08 | 2010-05-12 | Brian J. Cavanaugh | Method and apparatus for delivery of a ligating suture |
ES2628732T3 (en) | 2007-09-20 | 2017-08-03 | Sentreheart, Inc. | Devices and methods for remote suture management. |
US20090131749A1 (en) | 2007-11-21 | 2009-05-21 | Board Of Regents, The University Of Texas System | Tissue removal system and method using reinforced loop |
US8617145B2 (en) | 2008-01-25 | 2013-12-31 | Intrepid Medical, Inc. | Methods of treating a cardiac arrhythmia by thoracoscopic production of a Cox maze III lesion set |
US8834495B2 (en) | 2008-06-30 | 2014-09-16 | Arthrocare Corporation | Independent suture tensioning and snaring apparatus |
US20110178539A1 (en) | 2008-07-11 | 2011-07-21 | Holmes Jr David R | Left atrial appendage occlusion devices |
US8795298B2 (en) | 2008-10-10 | 2014-08-05 | Guided Delivery Systems Inc. | Tether tensioning devices and related methods |
US8961543B2 (en) | 2008-10-20 | 2015-02-24 | Mayo Foundation For Medical Education And Research | Tissue ligation devices and methods |
CN201317004Y (en) * | 2008-12-17 | 2009-09-30 | 王爱国 | Utility knife with stored blade |
US8317827B2 (en) * | 2009-01-07 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Suturing devices and methods |
US8388631B2 (en) | 2009-01-23 | 2013-03-05 | Restoration Robotics, Inc. | Skin tensioner for hair transplantation |
ES2705473T3 (en) | 2009-04-01 | 2019-03-25 | Sentreheart Inc | Tissue ligation device and controls thereof |
US9089324B2 (en) | 2009-05-04 | 2015-07-28 | Aegis Medical Innovations, Inc. | Suture locks and suture lock systems |
US10080482B2 (en) | 2009-06-30 | 2018-09-25 | Intuitive Surgical Operations, Inc. | Compliant surgical device |
US20110060350A1 (en) | 2009-09-04 | 2011-03-10 | Cost Containment, Inc. | Suture passer device and suture needle |
US9198683B2 (en) | 2009-09-30 | 2015-12-01 | Aegis Medical Innovations, Inc. | Tissue capture and occlusion systems and methods |
GB2474363B (en) | 2009-10-09 | 2013-09-25 | Acute Innovations Llc | System for tensioning a surgical wire |
US8845682B2 (en) | 2009-10-13 | 2014-09-30 | E-Pacing, Inc. | Vasculature closure devices and methods |
KR20110043799A (en) | 2009-10-16 | 2011-04-28 | 강호창 | Micro-coil assembly |
DK2493392T3 (en) | 2009-10-30 | 2016-08-01 | Cook Medical Technologies Llc | Apparatus for maintaining a force in a tissue using a loop element |
CN104997574B (en) | 2010-04-13 | 2017-06-06 | 森特里心脏股份有限公司 | For the method and apparatus to Cardiac interventional and placing device |
WO2012021207A1 (en) | 2010-06-03 | 2012-02-16 | Kl Medical Llc | Pericardial devices, systems and methods for occluding an atrial appendage |
US9017349B2 (en) | 2010-10-27 | 2015-04-28 | Atricure, Inc. | Appendage clamp deployment assist device |
EP3113692A4 (en) | 2011-01-11 | 2018-03-14 | Amsel Medical Corporation | Method and apparatus for occluding a blood vessel and/or other tubular structures |
US8556916B2 (en) * | 2011-02-14 | 2013-10-15 | Smith & Nephew, Inc. | Method and device for suture manipulation |
AU2012267914B2 (en) | 2011-06-08 | 2016-11-17 | Atricure, Inc. | Tissue ligation devices and tensioning devices therefor |
US8715302B2 (en) | 2011-06-17 | 2014-05-06 | Estech, Inc. (Endoscopic Technologies, Inc.) | Left atrial appendage treatment systems and methods |
IL218737A0 (en) | 2012-03-19 | 2012-07-31 | Tel Hashomer Medical Res Infrastructure & Services Ltd | Body part repositioning apparatus and method |
US9445857B2 (en) | 2011-07-21 | 2016-09-20 | Smith & Nephew, Inc. | Bone graft placement device |
US20150025312A1 (en) | 2011-08-09 | 2015-01-22 | Didier De Canniere | Introductory assembly and method for inserting intracardiac instruments |
CA2880030A1 (en) | 2012-07-26 | 2014-01-30 | University Of Louisville Research Foundation, Inc. | Atrial appendage closure device and related methods |
WO2014031903A1 (en) | 2012-08-22 | 2014-02-27 | Krishnan Subramaniam Chitoor | Methods and systems for accessing a pericardial space and preventing strokes arising from the left atrial appendage |
WO2014066340A1 (en) | 2012-10-22 | 2014-05-01 | Sentreheart, Inc. | Pericardial access devices and methods |
EP3378416B1 (en) | 2013-03-12 | 2020-07-29 | Sentreheart, Inc. | Tissue ligation devices |
CA2907125A1 (en) | 2013-03-15 | 2014-09-18 | Boston Scientific Scimed, Inc. | Tissue resection snares |
CN205322397U (en) | 2013-04-29 | 2016-06-22 | 凯伦医疗有限公司 | Stylolite can be fastened to axle pushing -type |
WO2014182806A1 (en) | 2013-05-07 | 2014-11-13 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Guiding medical devices and associated methods of manufacturing |
EP2994060A4 (en) | 2013-05-08 | 2016-12-14 | Sentreheart Inc | Tissue ligation devices and methods therefor |
CN105283135A (en) | 2013-06-14 | 2016-01-27 | Lc疗法有限公司 | Methods of performing cardiac surgical procedures and kits for practicing the same |
US10258408B2 (en) | 2013-10-31 | 2019-04-16 | Sentreheart, Inc. | Devices and methods for left atrial appendage closure |
US11266413B2 (en) | 2013-11-21 | 2022-03-08 | Atricure, Inc. | Occlusion clip |
EP3089674B1 (en) | 2013-12-30 | 2021-03-24 | AtriCure Inc. | Systems for left atrial appendage closure |
AU2015222963A1 (en) | 2014-02-28 | 2016-09-22 | Sentreheart, Inc. | Pericardial access devices and methods |
JP6332998B2 (en) | 2014-02-28 | 2018-05-30 | オリンパス株式会社 | Atrial ligation instrument |
JP6345465B2 (en) | 2014-03-31 | 2018-06-20 | オリンパス株式会社 | Atrial ligation instrument |
JP6396667B2 (en) | 2014-03-31 | 2018-09-26 | オリンパス株式会社 | Auricular ligation system |
EP3273866B1 (en) | 2015-03-24 | 2023-12-13 | AtriCure, Inc. | Devices for left atrial appendage closure |
US10130369B2 (en) | 2015-03-24 | 2018-11-20 | Sentreheart, Inc. | Tissue ligation devices and methods therefor |
US10786302B2 (en) * | 2015-10-09 | 2020-09-29 | Medtronic, Inc. | Method for closure and ablation of atrial appendage |
EP4331509A2 (en) | 2016-02-26 | 2024-03-06 | AtriCure, Inc. | Devices for left atrial appendage closure |
US11224435B2 (en) | 2016-09-23 | 2022-01-18 | Sentreheart Llc | Devices and Methods for left atrial appendage closure |
-
2017
- 2017-02-24 EP EP24152134.3A patent/EP4331509A2/en active Pending
- 2017-02-24 CN CN201780020887.2A patent/CN108882949B/en active Active
- 2017-02-24 EP EP17757372.2A patent/EP3419531B1/en active Active
- 2017-02-24 JP JP2018545199A patent/JP7137472B2/en active Active
- 2017-02-24 AU AU2017223996A patent/AU2017223996B2/en active Active
- 2017-02-24 CA CA3015804A patent/CA3015804A1/en active Pending
- 2017-02-24 WO PCT/US2017/019495 patent/WO2017147519A1/en active Application Filing
- 2017-02-24 US US15/442,216 patent/US10292710B2/en active Active
-
2018
- 2018-08-21 IL IL261281A patent/IL261281B/en unknown
-
2019
- 2019-04-04 US US16/375,660 patent/US11389167B2/en active Active
-
2022
- 2022-05-09 AU AU2022203085A patent/AU2022203085A1/en active Pending
- 2022-06-09 US US17/806,183 patent/US20220354501A1/en active Pending
- 2022-09-02 JP JP2022139882A patent/JP2022164896A/en active Pending
Also Published As
Publication number | Publication date |
---|---|
CN108882949A (en) | 2018-11-23 |
IL261281B (en) | 2022-05-01 |
US20220354501A1 (en) | 2022-11-10 |
JP2022164896A (en) | 2022-10-27 |
US20170245861A1 (en) | 2017-08-31 |
JP2019508136A (en) | 2019-03-28 |
JP7137472B2 (en) | 2022-09-14 |
CA3015804A1 (en) | 2017-08-31 |
US20190298376A1 (en) | 2019-10-03 |
EP3419531B1 (en) | 2024-04-03 |
AU2017223996B2 (en) | 2022-02-10 |
AU2022203085A1 (en) | 2022-05-26 |
US10292710B2 (en) | 2019-05-21 |
EP4331509A2 (en) | 2024-03-06 |
EP3419531A4 (en) | 2019-10-02 |
EP3419531A1 (en) | 2019-01-02 |
US11389167B2 (en) | 2022-07-19 |
AU2017223996A1 (en) | 2018-09-20 |
CN108882949B (en) | 2021-11-09 |
WO2017147519A1 (en) | 2017-08-31 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US11389167B2 (en) | Devices and methods for left atrial appendage closure | |
US10716571B2 (en) | Devices and methods for left atrial appendage closure | |
US11950784B2 (en) | Tissue ligation devices and controls therefor | |
AU2017272242B2 (en) | Tissue ligation devices and methods therefor | |
AU2015200980B2 (en) | Tissue ligation devices and controls therefor |